THE MUSKOGEE DIFFERENCE HEALTHCARE SCHOLARSHIP

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1 THE MUSKOGEE DIFFERENCE HEALTHCARE SCHOLARSHIP THE MUSKOGEE DIFFERENCE HEALTHCARE SCHOLARSHIP (MDHS) is designed to alleviate the financial burden of undergraduate students who are currently admitted and enrolled in Connors State College Nursing and Allied Health programs (AAS Nursing, AS Pre-Nursing, AS Biological Science-Pre-med, AS Biological Science-Allied Health or an approved CSC/ICTC Cooperative Alliance Degree Program). Students who receive the MDHS will be required to sign a commitment to work as a healthcare professional in the Muskogee service area for two years following graduation if employment is available. ELIGIBILITY The Muskogee Difference Healthcare Scholarship is available to residents of the primary Muskogee service area (see attached map). Verification of residency will be required (see requirements below). All applicants must be U.S. citizens or legal residents, meet the Oklahoma State Regents for Higher Education requirements for residency and be admitted into Connors State College with a declared major in either Nursing or Allied Health Sciences. Students who reside within the primary Muskogee service area (see attached map) must be able to provide proof of residency. Incoming freshman with a high school diploma or equivalent and an ACT composite score of 19 or above, or Returning Connors State College students in Nursing or Allied Health programs with a minimum cumulative GPA of 2.0, or Transfer students with a minimum GPA of 2.0 who are in good academic standing according to the Connors State College Satisfactory Academic Progress (SAP) Policy. REQUIREMENTS Students must be admitted and enrolled in an approved course schedule with a declared major in either the Nursing or Allied Health Science Programs. Completed MDHS Application submitted each semester. Recipient must sign a two-year Commitment to Work Agreement. Recipient must serve a two-year period of work as a healthcare professional within the Muskogee service area. Provide copy of Oklahoma Driver s License and/or copy of utility bill with students name and permanent address to establish proof of residency in the Muskogee service area Maintain a minimum 2.5 GPA in required degree courses. Remain continuously enrolled as a full time student at Connors State College. (Students who break full-time enrollment are eligible to reapply as a returning student.) Maintain good academic standing according to the Connors State College SAP Policy. Complete at least 67% of attempted coursework each fall and spring semester for a maximum of 6 semesters (not including summer semesters). A completed FAFSA submitted to Connors State College. One page typed essay describing student s desire to serve the Muskogee community. Students may apply for scholarship extension of up to two semesters. They must be accepted into an approved degree program to be considered for extension.

2 PROGRAM DESCRIPTION: The Muskogee Difference Healthcare Scholarship is intended to provide the needed funding to fill the gap between a student s financial aid and cost of attendance.* This scholarship has been created to pay the balance remaining after all federal, state and private funding has been applied to qualified expenses. The overall goal for the Muskogee Difference Healthcare Scholarship is to assist students in obtaining a degree in an allied healthcare field at no cost to the student. All scholarship applicants must apply for FAFSA and complete all FAFSA requirements in order to be considered. This scholarship is intended to assist students in the Muskogee service area (see eligibility and attached map). Financial Aid funds will be applied to the student s account in the below outlined order as funds are available. PELL SEOG OTAG OHLAP Outside Scholarships Tribal Grants & Scholarships CSC Scholarship (up to $1, per semester) Muskogee Difference Healthcare Scholarship Student Loans *Cost of attendance includes full tuition, fees, and books as funds are available. Developmental courses are not eligible under the MDHS. DEFAULT AND BREACH OF AGREEMENT: Recipient will be considered in default if he/she should fail to maintain continuous enrollment in an approved healthcare degree program at Connors State College. Failure to maintain the required GPA could also result in default. In the event the recipient should transfer to another educational institution, he/she will be required to submit proof of enrollment and/or transcript confirming enrollment in an approved degree program to the Scholarship Administrator. In the event that the recipient should fail any courses or program and wish to repeat courses, recipient must submit a formal, typed one page essay explaining the reasons for failing courses/program and resolutions to be considered for re-admittance to MDHS. Recipient will be considered in breach of Commitment to Work Agreement if he/she should fail to begin or to complete the period of work obligation. Default or breach of agreement will entitle Connors State College to recover from the recipient the total cost of scholarship awarded which will be charged back to the student s bursar account. Unpaid accounts will be assigned to collection if the account is not paid within 90 days. In the event your account is assigned to collection, any collection costs, court costs and/or attorney s fees owed will be added to the balance due. The balance due will be reported to national credit bureaus, which may adversely affect your credit rating. As with all unpaid accounts, a hold will be placed on transcript records and future enrollment until the balance is paid in full.

3 TRANSFERRING WORK SITE: Before transferring to another eligible worksite prior to completion of the required work obligation, the recipient must contact the Scholarship Administrator. The recipient will be required to submit a signed letter stating where he/she plans on going, along with a hire date and position description. The letter must also include the recipient s current address and contact information. APPEALS & WAIVERS: In cases where a recipient's compliance with the Commitment to Work obligation is impossible or would involve extreme hardship, as determined by the Scholarship Administrator, the work obligation and/or any damages for noncompliance may be waived partially or totally by the Scholarship Appeal Committee. Waivers will be considered on a case-by-case basis and all appeals must be submitted in writing. Recipient could be required to appear in person before the Scholarship Appeal Committee for a fair hearing.

4 THE MUSKOGEE DIFFERENCE HEALTHCARE SCHOLARSHIP Priority Deadline is May 1st and November 9th. All applications will be considered as funds are available. 1. Currently admitted and enrolled in Connors State College Nursing or Allied Health programs (AAS Nursing, AS Biological Science-Pre-med, AS Biological Science-Allied Health) or an approved CSC/ICTC Cooperative Alliance program, or 2. Incoming freshman with a high school diploma or equivalent and an ACT composite score of 19 or above, or 3. Transfer students with a minimum GPA of 2.0 who are in good standing according to the Connors State College Satisfactory Academic Progress (SAP) Policy. RETURN APPLICATION AND REQUIRED DOCUMENTS TO: Priority Deadline May 1st and November 9th Connors State College Muskogee Difference Scholarship Administrator Rt. 1, Box 1000 Warner, OK Application Section 1 To be completed by applicant. Please type or print in ink. Last First Middle CWID OK Mailing Address City State Zip County OK Physical Address City State Zip County Work Number Ext. Home Number Message Number Intended College Major Professional or College Address I reside within the primary Muskogee Service Area Applicant Signature Application Date Application Section 2 Must be completed by Connors State College Registrar Unweighted GPA Weighted GPA ACT Composite Graduation Date Comments: Registrar Signature Contact Telephone Number Date 0910

5 THE MUSKOGEE DIFFERENCE HEALTHCARE SCHOLARSHIP COMMITMENT FORM Academic Year THE MUSKOGEE DIFFERENCE HEALTHCARE SCHOLARSHIP COMMITMENT FORM MUST BE SIGNED BY THE STUDENT EACH ACADEMIC SEMESTER. THE STUDENT MUST ADHERE TO THE FOLLOWING GUIDELINES: 1. Must be currently admitted and enrolled in Connors State College Nursing or Allied Health program (AAS Nursing, AS Pre-Nursing, AS Biological Science-Pre-med, AS Biological Science-Allied Health or an approved CSC/ICTC Cooperative Alliance program). 2. Maintain a minimum 2.5 GPA. 3. Maintain continuous enrollment at Connors State College. 4. Complete at least 67% of attempted coursework each fall and spring semester for a maximum of 6 semesters (not including summer semesters). 5. A completed FAFSA submitted to Connors State College by deadline. 6. I have provided proof of residence (i.e., a valid driver s license) to the Admissions office. 7. I have provided the Admissions office with official transcripts from high school and/or college. 8. I,, have read and agree to the Default and Breach Agreement included in this application packet. 9. I,, understand that I must fulfill a two-year work commitment in Muskogee county following graduation. 10. I have been provided with a copy of the Scholarship rules and by signing this Commitment and Agreement I acknowledge the consequences of failure to comply with the Scholarship rules. 11. I,, understand that my student information will only be disclosed between CSC and the Muskogee Foundation. Student Name (Printed) Date Student Name (Signature) CWID For office use only: Rev. 1/2013 Date application received_ /_ /_ Semester scholarship will be applied_ /_ /_

6 Muskogee Difference Healthcare Scholarship Commitment to Work Agreement I,, understand and acknowledge that the Muskogee Difference Healthcare Scholarship program contains a two-year work obligation upon graduation and do hereby agree to the following terms and conditions of such work obligation. I further understand that if I do not maintain eligibility for the Muskogee Difference Healthcare Scholarship program or fulfill the service repayment, I will be required to reimburse Connors State College the monies received by me or paid on my behalf. I understand that the Muskogee Difference Healthcare Scholarship will cover the remaining balance of tuition, fees and books as funds are available at Connors State College after my financial aid is applied (not including loans) each semester. The Muskogee Difference Healthcare Scholarship cannot be applied to fines or other allowable charges on my account other than tuition, fees and books. I understand that the Muskogee Difference Healthcare Scholarship will only pay for one repeat of a previously passed course. More than one repeated course will not be calculated in my enrollment status pertaining to the Muskogee Difference Healthcare Scholarship. I understand that by signing this contract I will be obligated to enter a two-year service repayment program provided by Connors State College that is designed to prepare me to become a candidate for employment as a health care professional within Muskogee City/County. Initial I understand that I will be obligated to work within the Muskogee service area in a healthcare position for two years as agreed to on the Muskogee Difference Healthcare Scholarship Commitment Form I signed. In the case that I am unable to fulfill my commitment to work obligation or in the case of extreme hardship, as determined by the Scholarship Administrator, the work obligation and/or any damages for non-compliance may be waived partially or totally by the Scholarship Appeal Committee. If I am selected for a healthcare position in the Muskogee service area and complete my work obligation, the repayment obligation will be deemed satisfied in full. I understand that I must notify the Scholarship Administrator of my place of employment every six months in writing or immediately in the event I transfer to a new eligible workplace. I understand that I will be obligated to reimburse Connors State College for all scholarship monies received by me or paid on my behalf in the event any of the following should occur: I do not maintain continuous enrollment I am suspended from the college (conduct, grades, etc.) I change my field of study within two semesters of graduation I fail to contact the Scholarship Administrator upon graduation I fail to complete the work commitment obligation I fail to report a change in my employment status to the Scholarship Administrator within thirty days

7 I understand that if I am required to fulfill the reimbursement requirement instead of my work obligation, I must make satisfactory payment arrangements with Connors State College upon receipt of notification of reimbursement. Unpaid accounts will be assigned to collection within 90 days. Initial I understand the terms presented in this contract and policies presented in the application represent an agreement between parties and I certify that I have not relied upon any other representations made to me, either orally or in writing, in making my decision to sign this document and participate in this program. I understand that if I do not maintain eligibility for the Muskogee Difference Healthcare Scholarship program or fail to fulfill the work commitment, that Connors State College may take legal action against me which will include the total amount of monies paid to me or on my behalf and any and all attorney fees, filing fees, and other costs incurred in the collecting of this debt from me. By signing below, I declare that I have read the above agreement and consent to its terms and conditions. I further declare that I am of legal age and have the right to execute this agreement in my own name. Student Signature: Date: Signature: (Scholarship Administrator) Date:

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