2017 HELPING HANDS SCHOLARSHIP APPLICATION

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1 2017 HELPING HANDS SCHOLARSHIP APPLICATION Name: First Middle Last Phone: Mailing Address: Address City State Zip High School GPA: College Cumulative GPA: Area of Study: College you will be/are attending: Please complete the following checklist in full for your application to be considered: Read and sign attached Scholarship Criteria and Release Form. (page 2) Complete attached Scholarship and response questions. (pages 3 5) Attach income tax return from last year or income tax return of the person who claimed you as a dependent. Include a copy of high school transcript(s) and/or college transcript(s), if applicable. ALL APPLICATIONS MUST BE RETURNED TO THE BAPTIST HEALTH CARE FOUNDATION OFFICE BY: Noon, Friday, May 12 (Scholarship recipients will be notified by mail within four weeks after deadline.) Scholarship payments will be made directly to the college or university to the account of the student. Should the student elect to drop classes or is asked to leave due to disciplinary/academic probation, all unused scholarship dollars will be returned to Baptist Health Care Foundation. 1 of 5

2 Scholarship Criteria and Release Form Baptist Health Care is an Equal Opportunity Employer and has a strong commitment to diversity. Every opportunity will be made to ensure scholarships are granted to those most deserving. Scholarships will be managed by the Helping Hands Selection Committee and Baptist Health Care Foundation office. Scholarships are open to Baptist Health Care, Inc. team members, their dependents, and/or residents of the community. Scholarships will be awarded to those that meet the following criteria: - Qualified candidates must be enrolled in an educational institution within the Northwest Florida/South Alabama area. - Qualified candidates must be enrolled in an educational program vital to the health care needs of Northwest Florida/South Alabama. - Qualified candidates must reside in Northwest Florida/South Alabama. - Qualified candidates must be in good standing, if employed at Baptist Health Care. - Scholarships are awarded based on a combination of the following: academic excellence, financial need, demonstrated aptitude, and health care areas of critical need. Scholarship Release Form I understand that Baptist Health Care is committed to being a Drug-Free Workplace and an Equal Opportunity Employer. Therefore, scholarship opportunities will be awarded without regard to race, color, religion, national origin, disability, marital status, and/or any other status protected by law. I further understand that this scholarship application is only active for one year, after which I must reapply if I would like to be considered for scholarships again. I certify that the information provided by me on the attached application is correct and complete. Signature: Date: Print Name: SS Number: 2 of 5

3 APPLICANT INFORMATION: Please PRINT (in ink) or TYPE Are you employed now? YES NO Employer: Occupation/Position: How many hours a week do you work at this job? Do you have family members employed by Baptist Health Care, Inc.? YES NO Name of family member: Title/Department Name Are you a student now? YES NO IF YES, where are you enrolled? Estimated income last year? $ (MUST INCLUDE INCOME TAX RETURN) Are you the head of your household? YES NO Do you have any dependents? YES NO If YES, number of dependents: (Ages) Occupation of parent/spouse: Parent/Spouse employer: Estimated amount of parent/spouse annual support for your education: Are you receiving any other scholarship and/or financial assistance? YES NO IF YES, what kind? Have you completed the FAFSA form? YES If YES, please provide a copy. NO 3 of 5

4 EDUCATION HIGH SCHOOL (include a copy of transcript if you don t have a college transcript): High School: State: Graduation Date: GPA: COLLEGE (include a copy of transcript): Cumulative College GPA: Name of college(s) and Dates attended: Date you began (or will begin): Degree Selected: Expected Graduation Date: Briefly describe below how your specific degree will be used in health care: 4 of 5

5 List three references from current or previous employer(s) and/or former or present teacher(s). Include name, relationship to you, and phone number: Briefly describe why you should receive this scholarship: 5 of 5

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