FRIENDS OF SANFORD HEALTH SCHOLARSHIP

Transcription

1 FRIENDS OF SANFORD HEALTH SCHOLARSHIP Ten $1500 Friends of Sanford Health Scholarships are available to students in the SHNM service region and to present employees of Sanford Health of Northern Minnesota. To be considered for one of these scholarships, an applicant must be pursuing a career in a health related field, and not have been a previous recipient. This scholarship is contingent upon enrollment in an accredited school. It will be sent directly to the financial aid office of the chosen school for credit toward the student's educational expenses when a fee statement or proof of enrollment is received by the Scholarship Committee. A complete application MUST include the following information: A completed application form, An official transcript(s) from the school s scheduling office, including ACT and/or SAT scores (ACT/SAT scores needed for undergraduates, ONLY), A completed REFERENCE Form by a counselor/principal or supervisor, Two separate letters of recommendation (if currently a student, at least one MUST be from an instructor), in addition to the REFERENCE form enclosed in this packet, Postmarked by the deadline, March 15. Applicants are responsible to see that all necessary information is received by the committee. Incomplete applications will not be considered. Recipients of the scholarship will be notified by April 15. Please send completed applications to: The Scholarship Committee c/o Volunteer Office Sanford Bemidji 1300 Anne St. NW Bemidji, MN Fax:

2 Scholarship Application This scholarship is sponsored by Friends of Sanford Health. Please send completed form to: Volunteer Coordinator, Sanford Bemidji, 1300 Anne St. NW, Bemidji, MN The completed application is due March 15th PERSONAL INFORMATION Name: Permanent Address: Date: Home Phone: Current Phone (if different than home): Current Address (if different than above): ENROLLMENT CLASSIFICATION Address: Date of Birth: High School & Address: University or College & Address: Dates Attended: Graduation Date: Dates Attended: FUTURE PLANS In which health field do you plan to study or are you currently studying? To which schools have you applied? To which schools have you been accepted? Address of chosen school: What date will you begin the program in your chosen health field? Anticipated Completion Date:

3 BACKGROUND List your work experiences. List membership and participation in school and/or community organizations and activities List special honors/awards which you received while in high school, college, or technical college.

4 BACKGROUND Please state briefly your personal reasons for choosing a career in the health care field and for seeking this scholarship. I voluntarily give the Friends of Sanford Health Scholarship Committee the right to make an inquiry into my past academic activities and to contact the references I have listed. I release from liability any persons or institutions who provide said committee with any information. Signature Date:

5 FINANCIAL INFORMATION Father s Name: Mother s Name: Occupation: Occupation: What percentage of support do you receive from your parents? List the number and ages of other children dependent on your parents: Your marital status: Number and ages of children: Is spouse employed: Occupation: Applicant s Present Employment: Full or Part Time? Do you plan to work during vacations and/or school year? Is financial aid necessary to continue your education? List current indebtedness incurred for your educational expenses: List all grants and scholarships you have received: List all financial assistance you will apply for or have applied for other than this scholarship SOURCE AMOUNT PRESENT STATUS (Granted, Denied, Not Known) 3. 4.

6 Scholarship STUDENT Reference Students: PLEASE GIVE THIS PAGE TO YOUR COUNSELOR, PRINCIPAL, or SOMEONE WHO HAS WORKED WITH YOU IN A SUPERVISORY POSITION. APPLICANT S REFERENCE to be completed by Principal or Counselor. Student s Name: Name of School: Please rate student s potential for good academic performance in college: AVERAGE ABOVE AVERAGE VERY HIGH Please rate student s personal qualities: Cooperation Average Good Excellent Leadership Dependability Initiative and Drive Any additional comment to aid the Scholarship Committee will be greatly appreciated. Thank you for assistance in completing this form. TRANSCRIPT Official transcript MUST be included, showing student s academic performance and test scores, including ACT, SAT, etc. Signature and Affiliation with Applicant: Date:

7 Scholarship EMPLOYEE Reference THIS PAGE TO BE SUBMITTED ONLY BY SHNM EMPLOYEES applying for a scholarship for further education. Please give this to your DEPARTMENT HEAD or SUPERVISOR. APPLICANT S REFERENCE to be completed by Department Head or Supervisor Employee s Name: Department Please evaluate the candidate on each of the following factors: Cooperation Average Good Excellent Leadership Dependability Initiative and Drive How long have you known the applicant and in what capacity? REMARKS: Signature: Date: Position: