NCH Auxiliary Scholarship Application Form

Transcription

1 Dear Applicant: The NCH Auxiliaries are extremely proud to offer scholarships to students seeking careers in the healthcare industry. The purpose and intent of these scholarships is to encourage, support, and reward those who have an avowed interest in pursuing medical and healthcare studies. The NCH Auxiliaries have a long, successful history of providing financial support to students through their Health Careers Committee. These funds are made available through the commitment and dedication of the NCH Auxiliary members. Requirements Applicants are required to be an active NCH Auxiliary Volunteer or a Dependent Child of an NCH Employee. NCH Auxiliary Volunteer (To be considered you are required to): * Be an active NCH Auxiliary Volunteer and in good standing * Have volunteered a minimum of 50 hours prior to time of application submission * Seek a career in the healthcare field * Have a minimum 3.0 GPA, unweighted * Upon receipt of the scholarship, serve an additional 50 hours as an NCH Auxiliary Volunteer within 6 months or reimburse the Auxiliary the full amount of the scholarship awarded Dependent Child of an NCH Employee (To be considered you are required to): * Have a parent that is a current NCH employee with at least one (1) year of service and is in good standing * Seek a career in the healthcare field * Have a minimum 3.0 GPA, unweighted * You must complete and attach a typed essay, not to exceed 500 words. Include all of the following in your essay: why you chose healthcare as a course of study and future career; your short and long term goals; why you feel you are a top candidate to be chosen for this scholarship ALL Applicants are required to attach the below: * Proof of paid recent enrollment * Official school transcript; no more than thirty (30) days old * Two (2) reference letters; no more than thirty (30) days old 1

2 APPLICATION MUST BE COMPLETED IN FULL Active NCH Auxiliary Volunteer Active Auxiliary Volunteer ID# Location where you volunteer (check all that apply): Downtown Marco North Naples Central (Business/White Elephant) NCH East Other: Your volunteer job association/department: Dependent Child of NCH Employee Parent s NCH Employee ID# Parent s Full Name: Department/Unit: Parent s Telephone Number: Please PRINT your answers. If the application is illegible or incomplete it will be returned. 1 Last Name: First Name: 2 Current Mailing Address: Street City State Zip 3 Permanent Address (If different than above) Street City State Zip 4 Daytime Telephone Number ( )

3 6 High School Name: City State Dates Attended Graduation Date 7 College or Vocational School Name: City State) Zip 8 I have applied to the following school for the upcoming semester Name of School: *Attach proof of enrollment from the school 9 Grade Point Average, Unweighted (GPA): (on a 4.0 scale) *Minimum requirement is 3.0 *Attach most recent official school transcript 10 List your academic honors, awards and club memberships/activities: 11 List your employment within the last 5 years (part-time and full-time) Employer(s) name, address, type of work, date(s) *You may attach a resume* 13 List your community service activities, hobbies, outside interest and extracurricular activities: 3

4 14 How did you hear about our scholarship program? (check off all that apply) From an NCH Employee From the NCH Website From an NCH Volunteer From the Auxiliary Facebook page Other 15 I am applying for an NCH Auxiliary $1,000 Scholarship (Select campus applying to) NCH North Campus NCH Downtown Campus Marco Campus *Note: You may only apply at one campus. If your application is approved the scholarship check will be disbursed directly to your account at your school. You will receive a copy of the check for tracking purposes. 16 Have you previously received a scholarship from NCH? (check one) NO YES List Date(s) and Amount(s) ATTACH THE FOLLOWING DOCUMENTS 1) Proof of enrollment 2) Official school transcript 3) Two (2) reference letters 4) All pages of this application 5) Essay, required for Dependent Child of NCH Employee Only (not required for NCH Auxiliary Volunteer) NOTE: * Incomplete applications will be returned. * An interview in-person is required; you will be called to schedule an appointment. * Scholarship funds CAN NOT be used for personal living expenses. * Scholarship checks are disbursed directly to the school. * The Auxiliary Board meets 6 times a year, you will be notified once your complete application has been reviewed by the Board (Downtown & North Naples). The Marco Auxiliary Board reviews scholarship applications one time per year. * You acknowledge that if you do not complete your studies or otherwise fail to meet the scholarship requirements you must immediately repay the scholarship. Applicants Signature Date (MM/DD/YYYY) 4

5 *********************************************************************************************************** *********************************************************************************************************** FOR INTERNAL USE ONLY: AUXILARY BOARD ACTION TAKEN: (MM/DD/YYYY) ACTION TAKEN: APPROVED DECLINED DEFERRED REASON FOR DEFERRED: 5