Mercy Medical Center Minority Scholarship

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1 Mercy Medical Center Minority Scholarship Purpose: To provide financial assistance up to $5,000 to a minority student entering any field that relates to positions with Mercy Medical Center. Requirements: Applicant must be enrolled or enrolling in an accredited school or program for the Fall term with the goal of obtaining a certificate, Associate Degree or Bachelor Degree. Please include copies of acceptance letter(s), if applicable. Maintain a GPA of at least 2.5 on a 4.0 scale and good attendance records. Applicants must be citizens or permanent residents of the United States. Applicants must be residents of Stark County and a senior student attending either McKinley High School or Timken High School. Must submit an official, sealed transcript with in-progress grades. Must provide two letters of recommendation (using attached reference forms) supporting academic achievement, leadership, and communication skills from a recent teacher, professor, counselor, advisor or manager/supervisor. Must submit a personal statement of 250 words or more identifying applicant s: a) future goals, b) reason(s) for pursuing a healthcare career, c) what Mercy s mission means for your life or how you have demonstrated Mercy s mission, d) plan for academic and career success, e) leadership and commitment, f) extracurricular activities, g) employment, h) determination and i) self-motivation. Proficient communication skills that demonstrate a passion for healthcare and a familiarity with healthcare profession demands Process: Applications must be received complete and postmarked by March 31 st. Selected recipient(s) will be notified by May 15 th. A face-to-face interview with each finalist and the Scholarship Committee. A rating/point system established by the selection committee will assist with the selection process. Once a scholarship has been awarded, the recipient will be assigned a mentor who is a Mercy Medical Center employee working in the scholarship recipient s healthcare field of interest. The recipient is required to maintain contact with his/her mentor throughout the academic year. Frequency of contact will be a consideration for future applications for the scholarship. Volunteer work is encouraged. 1

2 Personal Information Scholarship Application Name: First Middle Last Permanent Address: Phone Number: Alternate Phone Number: Address: Social Security Number: Gender: Male Female Date of birth: Ethnic Group: African American Hispanic Native American Asian Education Multi-racial Other High School: Address: Class Standing (if known) Year of Graduation Current GPA Cumulative GPA Honors or Awards: Extracurricular Activities: College Test/Placement Scores (if taken): ACT SAT COMPASS School/College/Program you plan to attend: Have you applied? Yes No Have you been accepted? Yes No This school s grading period is Semester Quarter Trimester If you have declared a major, what is it? During the school year, you will be a Full-time student Part-time student Have you applied for financial aid at that school? Yes No 2

3 If you are not sure which school you will be attending or have not yet been accepted, please list the schools to which you have applied and the application status for each (i.e., waiting, accepted but waiting on other applications, etc.) School Application Status Applied for Financial Aid Yes No Estimated costs per year (tuition, fees and books only) Work Experience (List most recent first. Include volunteer work) Company Address Supervisor Phone Position Hours per week Rate of pay Duties Dates of Employment: From To Volunteer work If not your current employer, did you work out a 2-week notice? Yes No Company Address Supervisor Phone Position Hours per week Rate of pay Duties Dates of Employment: From To Volunteer work If not your current employer, did you work out a 2-week notice? Yes No 3

4 Recommendations/References Letters of recommendation have been requested from: Name Mailing Address How does the person know you? How long have they known you? Financial Information *In addition to this Financial Statement, if you received a Student Aid Report (SAR) from the U.S. Department of Education, please attach. Part A From what schools and/or agencies have you applied for scholarships or other financial aid? Type Government Grants Government Loans School-Based Scholarships School-Based Loans Other (Itemize and describe) Amount Applied For Amount Awarded (if known) Amount Awarded last year (if applicable) Part B. Estimated income for the NEXT academic year Parent(s) contribution $ Spouse(s) contribution $ Other Personal Earnings $ Loans $ Grants $ Other (specify) $ Total Estimated Income $ 4

5 Personal Statement In the space below, submit a personal statement of 250 words or more indentifying your: a) future goals, b) reason(s) for pursuing a healthcare career, c) what Mercy s mission means for your life or how you have demonstrated Mercy s mission, d) plan for academic and career success, e) leadership and commitment, f) extracurricular activities, g) employment, h) determination and i) self-motivation. 5

6 Affidavit I hereby certify that I am an African-American, Native American, Hispanic, Asian or multiracial United States Citizen. I certify that this application contains no misrepresentations or falsifications, and that the information given by me is true and correct to the best of my knowledge. I understand that any false statements made herein will void this application and I will be ineligible for financial support. If selected, I also agree to potential employment with Mercy Medical Center while receiving benefits from scholarship or upon graduation. Signature of applicant Please print name Date 6

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