ANTHC SCHOLARSHIP APPLICATION

Transcription

1 ANTHC SCHOLARSHIP APPLICATION Fall 2014 Scholarship Application Alaska Native Tribal Health Consortium (ANTHC) is a private non-profit, tax-exempt corporation that compacts with the federal government to provide healthcare-related services to over 140,000 Alaska Natives and American Indians. ANTHC s major programs include Administration, Community Health, Information Technology, Human Resources, Environmental Health and Engineering, and the Alaska Native Medical Center, which is managed in cooperation with Southcentral Foundation.

2 ALASKA NATIVE TRIBAL HEALTH CONSORTIUM 3900 Ambassador Drive, Suite ANTHC Scholarship Application ANTHC awards ten (10) scholarships up to $5,000 per academic year to Alaska Native or American Indians, who are: Permanent Alaska residents Interested in working in the healthcare field Currently enrolled in a formal education or training program This scholarship may be used for tuition, books, and fees for professional certificate programs or higher education degrees (Associates, Bachelors, Graduate and PhDs). ANTHC grants these scholarships as an integral part of its long-term strategy to increase Alaska Natives and American Indians in the healthcare field. Selection Process Education, Development and Training reviews submitted applications for completeness and administers the evaluation process. Up to twenty (20) finalists will be chosen for interview based on the evaluation results. The finalist interview evaluates potential to succeed, leadership, and contribution to the Alaska Tribal Health System. The following criteria are considered during the selection process: Personal statement of how the Alaska Tribal Health System would benefit from your educational pursuit Letters of recommendation Presentation of application Involvement in the Native community An appointed committee conducts a final review of the application evaluations, results of the finalist interview, and makes an official selection of awarded applicants. Application Due Date Completed applications and attachments must be received or postmarked by Friday, June 20, Applications may be delivered to ANTHC Education and Development, 3900 Ambassador Drive, Anchorage, AK in person between 8:00 am and 4:30pm or postmarked by Friday, June 20, Notification of Award Award notifications will be made available by Friday, July 18, Page 2

3 ALASKA NATIVE TRIBAL HEALTH CONSORTIUM 3900 Ambassador Drive, Suite 101 Scholarship Award Requirements Awarded ANTHC Scholarship recipients must meet the following award requirements. All rights to the ANTHC Scholarship funding are waived if award requirements are not met. Complete and submit all required documents by the specified deadlines Maintain full-time status throughout their program (Undergraduate, Graduate, PhD or Certificate) and successfully complete their program Maintain cumulative GPA of at least 2.5 (if applicable) Adhere to all other requirements outlined in the ANTHC Scholarship Recipient Agreement If you have any questions, please contact: ANTHC Education, Development and Training Phone: (907) Toll-free: 1 (800) learning@anthc.org Page 3

4 ALASKA NATIVE TRIBAL HEALTH CONSORTIUM 3900 Ambassador Drive, Suite 101 Scholarship Application Requirements Application Form Please complete the attached scholarship application form, use the checklist to ensure you have everything and submit the following required documents. Proof of Tribal Eligibility Provide verification of Alaska Native or American Indian status, submit one of the following: A copy of your Tribal enrollment card from a Federally recognized Tribe A copy of your Certificate of Indian Blood (CIB) from the Bureau of Indian Affairs Alaska Residency To demonstrate Alaska residency, submit a copy of two of the following: Your Alaska Driver s License Your Alaska Voter Registration Card Your State of Alaska Birth Certificate Proof of eligibility for you to receive an Alaska Permanent Fund Dividend (PFD) from the previous year Your Federal income tax return from the previous year; or the tax return of one of your parent s/legal guardian s listing you as a dependent, along with evidence of your parent s/legal guardian s Alaska residency Personal Statement Submit a personal statement answering the following questions: Note: Additional pages will not be reviewed. Why are you applying for the ANTHC Scholarship? What is your professional and educational history? What are your educational and career goals? How does this education/training fit within your educational and/or professional goals? How are you involved in the Native community? Any awards or honors received. How will your educational goals contribute to Tribal health systems and to the health of the Native people? Note: Your personal statement should be typed with a 12-point font and be no longer than one paged. Letters of Recommendation Submit two (2) letters of recommendation from teachers, employers, or persons with knowledge of your experience, potential to succeed, and community involvement. Letters should state professional relationship and length of association. Note: Letters of recommendation from the applicant's family related by blood or marriage will not be reviewed. Page 4

5 ALASKA NATIVE TRIBAL HEALTH CONSORTIUM 3900 Ambassador Drive, Suite 101 Letter of Acceptance or Proof of Application Submit a copy of one of the following: A letter of acceptance or good standing from an accredited college/university dated the current year with your major, degree and full-time status; or A copy of your application for admission to the accredited college/university if you have not yet received your letter of acceptance; or A letter from the accredited college/university dated the current year stating your application for admission is currently under review A letter of acceptance or an invoice into a training program Official Education or Training Transcripts/Documentation Submit the following if you applying for a higher education degree program: Official transcript from the last vocational school, college or university attended* Official transcripts from the high schools you graduated from IF you have not attended a vocational school, college, or university Official proof and date of completion if General Equivalency Diploma (GED) was obtained if you have not attended a vocational school, college, or university * It is recommended that applicants verify with their educational programs(s) that transcripts have been sent and that the student request all official transcripts at a minimum of two weeks before the application deadline as processing time for official transcripts varies per university. All transcripts must be postmarked on or before the deadline in order for an application to be considered complete. You may also come in to the Education, Development and Training office and print them off in person. All of the documents listed must be submitted by the deadline in order for your application to be considered complete and forwarded to the scholarship committee. Incomplete applications will not be reviewed. Additional attachments will be discarded and all submitted materials cannot be returned. Submit the following if you are applying for a professional certificate program: All of the above A current resume That includes the following information: Career Objective Skills/Experience Employment History Education Volunteer Experience Any awards or honors received Affiliations Page 5

6 Application Checklist-For Your Use Only APPLICATION ALASKA NATIVE TRIBAL HEALTH CONSORTIUM 3900 Ambassador Drive, Suite101 PROGRAM APPLYING FOR IDENTIFIED Clearly indicate which program in the application DOCUMENTATION OF ALASKA NATIVE/AMERICAN INDIAN ELIGIBILITY PERSONAL STATEMENT No longer than one page, typed, and use of a 12 point font ENCLOSE (2) LETTERS OF RECOMMENTATION Ensure that all signatures are obtained in the application packet LETTER OF ACCEPTANCE OR ENROLLMENT DOCUMENTATION OF ALASKA RESIDENCY ENCLOSE OR SEND OFFICIAL TRANSCRIPTS Submit one of the following options: Official transcripts from last vocational schools, colleges and universities attended 1 Official transcripts from the high schools attended if I have not attended a vocational school, college, university Official proof and date of completion if I obtained a General Equivalency Diploma (GED) and have not attended a vocational school, college, or university RESUME IN FORMAT REQUESTED IF APPLYING FOR PROFESSIONAL CERTIFICATE PROGRAM I understand that an incomplete application will not be reviewed, additional materials will be discarded and all submitted materials become the sole property of ANTHC and cannot be returned. 1 Official transcript or copy of an official transcript copy must be made in the Education, Development and Training (EDT) office; you may also print off a copy of your transcripts at the EDT office from your official student account from your educational program. Page 0 of 4

7 Application Form ALASKA NATIVE TRIBAL HEALTH CONSORTIUM 3900 Ambassador Drive, Suite101 Personal Data Are you a previous Recipient: Yes No If yes, list years awarded Years Awarded First Name: First Last Name: Last Maiden Name: If Applicable Male of Female: Place of Birth Social Security Number M F City, State XXX-XX-XXXX Current Contact Information Date of Birth: Mo/Day./Year Address: Address Home Phone: Phone City: City Work Phone: Work State: State Cell Phone: Cell Zip: Zip Eligibility Ensure the AN/AI eligibility documentation is from a federally recognized Tribe and not from a Native Corporation for example: CIRI, Doyon, BBNC I am : Alaska Native American Indian Enrolled in federally recognized tribe: Yes No Tribal Affiliation: Name of Tribe I am an Alaska Resident: Yes No School Education/Certification Program Information List the accredited college/university or certification program you are currently enrolled in. School/Program: School Name Address: School Address City/State/Zip City, State Zip Field of Study (Major) Enter Major of Study Here Term Start Date: Month/Day/ Year Number of Credits you will be taking: Enter Number of Credits Degree Program for Application Period Associate Bachelor Master Doctorate Expected Graduation Date: Month/Day/Year Is this full time status: Education Program: Yes No Level of Study for Application period Freshman Sophomore Junior Senior Grad Student Semester Trimester Quarter Page 1 of 4

8 PREVIOUS EDUCATION Vocational School/College/University ALASKA NATIVE TRIBAL HEALTH CONSORTIUM 3900 Ambassador Drive, Suite101 City State Zip Start Date School Name City State Zip Month/ Day/Ye ar School Name City State Zip Month/ Day/Ye ar School Name City State Zip Month/ Day/Ye ar School Name City State Zip Month/ Day/Ye ar HIGH SCHOOL End/ Graduatio n Date Month/Day/ Year Month/Day/ Year Month/Day/ Year Month/Day/ Year High School City State Zip Start Date Graduate Date (Month/Year) School Name City State Zip Month/Da y/year School Name City State Zip Month/Da y/year Major Degree Credits Earned Major Degree Credits Major Degree Credits Major Degree Credits Major Degree Credits Month/Year Month/Year If you are attending a certificate program instead of a college or university please complete: CERTIFICATE PROGRAM Organization Address City State Zip Organization Name Mailing Address City State Zip Phone Number Website Phone Number Web Address Is this certification/training program for your goal of being employed with tribal health? Yes No This professional certification is for my current career field Yes No If no for both questions, how does this fit into your overall career goals? Career Goals Statement Start Date Month/Day/Year Expected Graduation Date Month/Day/Year Is this full time status? Yes No Page 2 of 4

9 ALASKA NATIVE TRIBAL HEALTH CONSORTIUM 3900 Ambassador Drive, Suite101 How did you hear about the ANTHC Scholarship Program? Type information here Statement of Certification I do hereby attest that the information I have provided and included in this application is true, correct, and complete. I do understand that the proceeds of the ANTHC Scholarship, if approved, will be used to further my education in the educational program where I am enrolled and for the period of time indicated in the guidelines as approved by ANTHC. If for any reason the scholarship is not used, the full amount or any portion of it is refundable to ANTHC. I do understand that I will need to submit my ANTHC Scholarship Recipient Agreement and Recipient Course Schedule to the Education and Development office within ten (10) working days of the start of the semester/quarter/trimester. I do understand that I will need to submit my official transcripts within (15) working days upon completion of the semester/quarter/trimester. The official transcripts will be sent to ANTHC, Education and Development, 3900 Ambassador Drive, Suite 101, Anchorage, AK ANTHC will not pay for fees related to the acquisition of official transcripts. In order to continue to receive the ANTHC Scholarship, I understand that I must maintain a GPA of at least 2.5, for each semester/quarter/trimester in which I am enrolled and I understand that I must maintain an enrolled status as a student during the current semester/quarter/trimester; complete and pass the program or semester. I have read and understand the above STATEMENT OF CERTIFICATION and, if approved, agree to abide by the terms and conditions of the scholarship. Name of Applicant (printed or typed) Applicant Signature Date Page 3 of 4

10 Parental Consent (if the above applicant is a minor) ALASKA NATIVE TRIBAL HEALTH CONSORTIUM 3900 Ambassador Drive, Suite101 I/We,, the parent(s)/guardian(s) of the above minor applicant,, do hereby attest that the information provided and included in this application is true, correct, and complete. I/We do understand that the proceeds of the ANTHC Scholarship, if approved, will be used to further my child s education in the college/university where he/she is enrolled and for the period of time indicated in the guidelines as approved by ANTHC. If for any reason the scholarship is not used, the full amount or any portion of it is refundable to ANTHC. I/We do understand that immediately upon completion of the semester or term, my child shall have the college/university submit to ANTHC an official grade transcript of the semester/ trimester/ quarter during which the award was used. The official transcripts will be sent to ANTHC, Education and Development, 3900 Ambassador Drive, Suite 101, Anchorage, AK ANTHC will not pay for fees related to the acquisition of official transcripts. In order to continue to receive the ANTHC Scholarship, I/we understand that my child must maintain a grade point average of at least 2.5 for the current semester/quarter/trimester which my child is enrolled. Name(s) of Parent(s)/Guardian(s) Parent(s)/Guardian(s) Signature(s) Date. Page 4 of 4