A scholarship of up to $4,500 will be presented to a full time North Central State College student who meets the qualifications as outlined below.

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1 This application is for the Dr. George Searle Physical Therapy Scholarship The award amount is for up to $4,500 annually to be used toward tuition and/or other College expenses (such as for books and lab fees). One scholarship, renewable for two additional years, will be awarded for the school year. The Eleanor Searle Whitney McCollum Foundation of Cypress, Texas, in conjunction with the North Central State College Foundation, is establishing an endowed scholarship fund with the College Foundation in the name of Dr. George Searle to benefit students at North Central State College enrolled in the Physical Therapy Assistant s Program (PTA). A scholarship of up to $4,500 will be presented to a full time North Central State College student who meets the qualifications as outlined below. To qualify for this scholarship, the following criteria must be met: The annually-renewable scholarship of up to $4,500 will be given to one full-time North Central State College student entering the Physical Therapy Assistant degree with a 3.0 grade point average either from high school or previous college experience. The applicant must be from Plymouth, Ohio, or from rural Huron or Richland counties and may receive up to $4,500 annually for each of three years for tuition, books, fees, and/or other costs of college as necessary and determined by the College s Financial Aid Office. The scholarship recipient must maintain a 3.0 cumulative grade point average for annual renewal. At the conclusion of three years or if the scholarship recipient s grade point average falls below 3.0 or when the scholarship recipient has graduated with a Physical Therapy Assistant degree, whichever is first, a new scholarship award will be presented to another qualified student. An application with transcript(s) must be sent in one envelope to the College Foundation Office on or before March 30, Incomplete applications will not be considered. The recipient of this scholarship will be notified via mail. The student must accept or decline the award and return all required paperwork to the College Financial Aid Office before the scholarship is awarded. March 30, 2012, is the deadline for submitting the application and transcript to Foundation Scholarships-Searle PTA, North Central State Foundation, P.O. Box 698, Mansfield, Ohio

2 Directions: The North Central State College Foundation annually offers scholarships to qualified students. Incomplete applications will not be considered (enter N/A if the question on this form does not apply to you). Only applications from those who have applied for admission to North Central State College will be considered. Include your most recent high school or college grade transcript with this application. See qualifying information on cover sheet. Submission: The application deadline is March 30, Submit the completed application and transcript in one envelope to Foundation Scholarships, North Central State College Foundation, 2441 Kenwood Circle, P.O. Box 698, Mansfield, Ohio 44901, or drop it off at the Foundation office, 122 Kee Hall. Contact with any questions. Section I Name: SSN or Student ID Number Address: City: State: Zip Code: Phone Number: Dr. George Searle Physical Therapy Assistant Scholarship Application North Central State College Foundation Name of High School: Class Rank: Size of Graduating Class: Intended College Major Program of Study: List any school and community extra-curricular activities, and any leadership positions held: List any school and community awards or recognitions you have received: Have you participated in a post-secondary education program? Yes No If so, at what institution? How many credit hours have you earned and in what field?

3 Please provide two references, in addition to the letter of recommendation. Name, title, phone number Name, title, phone number Section II Why are you interested in physical therapy as a career? The information provided on this application and on supporting documentation is true and complete to the best of my knowledge. If selected to receive a North Central State College Foundation scholarship, I authorize the College or the College Foundation to use information relating to my selection for the purpose of publicity. Signature Date Application Deadline is March 30, 2012 Return with Transcript to the North Central State College Foundation Office, 122 Kee Hall OFFICE USE ONLY Credit Hrs Major GPA EFC Pell SO

4 Section III Letter of Recommendation (type or print) Name of Applicant: is applying for the Searle Physical Therapy Scholarship for North Central State College. Your answers to the following questions will aid the selection committee in choosing the best candidate to receive this award. Thank you for your assistance. 1. How long and in what capacity have you known the applicant? 2. What is your estimate of the applicant s potential for success in college? 3. How would you describe the applicant s motivation and commitment to achieving his/her goals? 4. Please add any comments that would, in your opinion, support the suitability of this candidate to receive the Physical Therapy scholarship.

5 Print or Type Name: Position: Phone Number Address: Signature: Please Return this Recommendation by March 30, 2012, to: Foundation Scholarships-Searle PTA North Central State College Foundation P.O. Box 698 Mansfield, OH

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