CCHN Health Professions Initiative Program Overview Introduction and Background: On April 1, 2005, Colorado Community Health Network (CCHN) was awarded a grant from The Colorado Trust to increase the number of qualified health professionals serving underserved areas in Colorado. The goal of CCHN s Health Professions Initiative (HPI) scholarship program is to assist Community Health Centers (CHCs) in training highachieving, entry-level staff to become allied health professionals or clinical support staff. CCHN s program aims to help these employees achieve their professional goals, while keeping them employed in the underserved areas of Colorado. Award: Scholarships up to $5,000 are available for qualifying CHC employees who are seeking to further their careers as an allied health professional and/or clinical support staff member. A health professional is a person who preserves or improves the health of individuals, or cares for individuals who are injured, sick, or disabled. An allied health professional and/or clinical support staff member provides this same kind of direct clinical care at basic levels in the medical setting. An allied health profession or clinical support staff position may include professions such as dental assistant, dental hygienist, expended duties dental assistant, lab technician, licensed practical nurse, medical assistant, nursing aide, pharmacy technician, phlebotomist, registered nurse, ultrasound technician, and x-ray technician (please note that this is not an exhaustive list; however, CCHN cannot issue scholarships for positions higher than a registered nurse). CCHN scholarships are available ONLY for tuition costs and tuition-related fees. CCHN does not provide scholarship funds for books, supplies, unrelated tuition fees, or for personal development classes. Scholarship payments will be made directly to training institutions for an awardee s tuition balance. Before CCHN provides payment, the awardee must show proof of acceptance and enrollment to a training institution. CCHN now provides scholarships for prerequisite courses; however, the awardee must currently be completing the last year of prerequisite courses before entering a health professions training program. If an awardee is accepted to a health professions program at a training institution, however is not yet enrolled, scholarship payments will not be made until the awardee enrolls and begins attending school. Applicants who have recently completed or are close to completing their health professions training are welcome to apply for the HPI scholarship even if they will not accrue an additional tuition balance before graduation. If loans were used to pay tuition and tuition-related expenses, CCHN will make payments directly to loan holders for loans obtained up to 12 months before receiving the HPI scholarship award. CCHN, Health Professions Initiative Scholarship Round Five Application Package, Page 1
Some awardees will be required to commit to employment at their CHC following the completion of their training; the employment commitment is determined by each individual CHC. Eligibility and Requirements: The applicant must be currently employed and in good standing with a Community Health Center (CHC) in Colorado. For a complete list of CHCs in Colorado, visit www.cchn.org. Note: Existing CHC employees receive first preference for this scholarship; however, volunteers are also eligible to apply as long as they have volunteered at the same CHC for 2 years. The applicant must be enrolled and in good standing with a training institution. If currently completing prerequisite courses, the applicant must have no more than one year of prerequisite courses to complete before entering a health professions training program. The applicant must be requesting a scholarship to be applied to tuition-related expenses for a health professions program or requesting a scholarship to pay back a loan obtained for tuition-related expenses for a health professions training program in the last 12 months. The applicant must further his/her education in an allied health profession or clinical support staff position, that provides direct patient care at CHCs. If awarded, the applicant must comply with all of CCHN s scholarship obligations. For the duration of his/her schooling, the applicant must hold a minimum required GPA (on a scale of 4.0). The minimum GPA is determined by the applicant s CHC; however, the minimum GPA can be no lower than 2.5. The applicant may be required to complete an employment commitment to the CHC once training is complete; this is determined by each individual CHC. Selection Criteria: All applications will be reviewed and scored by an advisory committee to verify that all eligibility requirements have been met. Applications will be considered based upon CHC staff recommendations. Applicants who best demonstrate their commitment to serving underserved populations are highly desirable. Applicants who are already enrolled and attending a health professions training program are highly desirable. Applicants who are from disadvantaged backgrounds are highly encouraged to apply. All applications will be reviewed to ensure geographic and provider-type diversity among awardees. CCHN, Health Professions Initiative Scholarship Round Five Application Package, Page 2
Application Process: 1. Complete and sign all documents in this HPI scholarship application package. 2. Obtain a CHC sponsoring official signature on necessary documents (this may be from your direct supervisor, your human resources director, or another executive level employee at your CHC). 3. Obtain a letter of recommendation from a CHC sponsoring official (this may be from your direct supervisor, your human resources director, or another executive level employee at your CHC). 4. Create a personal statement. 5. Obtain the required materials from your training institution describing your training program. 6. Obtain documentation of acceptance to, enrollment in, or completion of a health professions training program. 7. Obtain documentation of the total cost to complete your training. 8. Return completed application package to your CHC s HR department. Your CHC s HR department will conduct an initial internal review of the application package to determine eligible applications and submit qualifying applications to CCHN. 9. CCHN s Workforce Advisory Committee, the committee that provides feedback on the policies and procedures of the HPI scholarship program, will review and score applications. 10. Once your application has been received and reviewed, CCHN will contact you as soon as possible. Scholarship awards are typically decided approximately one month after the application deadline. CCHN, Health Professions Initiative Scholarship Round Five Application Package, Page 3
CCHN Health Professions Initiative Scholarship Application Form (Please write legibly) Last Name:_First Name:_ Business Mailing Address: Phone (please provide the best number to reach you): Best time of day to reach you at the above number: Business Fax: E-mail address you most frequently check:_ Current Community Health Center (CHC): Length of time employed/volunteered with CHC: Current position with CHC: Current salary at CHC: Are you multilingual? Yes No If so, in what languages? Health professions course of study: Training institution already attending or attended (name and city): 1. Are you applying for a scholarship to pay back a loan for health professions training you have already completed? If yes, answer N/A on questions 2-6. Yes No 2. Have you already been accepted into a health professions training program (for example nursing school, the licensed practical nursing program, the expanded duties dental assistant program, etc)? If so, you will be asked to provide documentation of your acceptance. Yes No N/A 3. If you answered no to the question above: Do you have one year or less of prerequisites remaining to complete before entering a health professions training program? If not, you are ineligible for this scholarship. Yes No N/A CCHN, Health Professions Initiative Scholarship Round Five Application Package, Page 4
4. If you are currently attending prerequisite courses, when did you start prerequisites and when do you plan to complete them and begin your health professions training? 5. If you are currently attending health professions training, when did you start and when do you plan to complete your training? 6. If you have been accepted to a health professions training program, but you have not yet started, when are you planning to enroll and start attending? 7. What scholarship amount are you applying for? (you may apply for up to $5,000 if the cost of your tuition equals or exceeds $5,000) 8. What is the total tuition cost to complete your health professions training? (you must provide documentation of this cost) 9. Are you receiving tuition funds from other sources? 10. If so, how much and from which sources? Applicant Signature: Date: *The preceding information and answers are true and correct to the best of my knowledge CHC Sponsoring Official Signature (must be human resources director or executive level employee in the applicant s organization):date: *The preceding information and answers are true and correct to the best of my knowledge CCHN, Health Professions Initiative Scholarship Round Five Application Package, Page 5
CCHN Health Professions Initiative Scholarship Obligations (Please initial each line) I agree to abide by the following scholarship obligations of this award if I am a recipient. I understand that payments of funds awarded will be made directly to my training institution or loan holder and will be applied only to my tuition. I understand that I will sign an agreement stating that any excess tuition funds paid directly to me will be used for paying ONLY future tuition and tuition-related fees, if applicable. I understand that I will be required to submit several reports to document that I have used excess tuition funds paid to me directly for paying ONLY future tuition and tuition-related fees, if applicable. I understand that I will be required to maintain a minimum GPA, determined by my CHC (not below 2.5, on a scale of 4.0). I understand that I am responsible for ensuring that CCHN s Workforce Development Coordinator receives documentation of (if awarded you will be sent most of the following documents in an acceptance package via mail): Acceptance to, enrollment in, or completion of a health professions program at an approved training institution A current tuition balance and the full cost to complete the health professions training Financial aid contact information A signed release of information form A signed survey consent form A completed pre-program survey A signed excess tuition funds agreement (if applicable) Several excess tuition funds scholarship reports (if applicable) I understand that I must immediately notify CCHN s Workforce Development Coordinator if I change schools, discontinue my enrollment, or change my course of study. I understand that upon successful completion of my health professions degree and/or certificate, I may be required to serve an employment commitment at my CHC for a time period determined by my CHC. I understand that while I may be obligated to fulfill my employment commitment to my CHC, my CHC is not required to employ me after completion of my training. I understand that the time I am attending health professions training does not count towards work hours or my employment commitment. CCHN, Health Professions Initiative Scholarship Round Five Application Package, Page 6
I understand that if I do not complete my health professions degree and/or certificate or my employment obligation to my CHC (if required), I will be personally responsible for reimbursing CCHN the money that was awarded to me in full on the date of separation from training and/or employment. I understand that I may reapply for this scholarship in succeeding years/scholarship rounds as long as I am in good standing at my CHC and my training institution. I understand that CHC volunteers are eligible to apply for the HPI scholarship program; however, existing CHC employees receive preference for available scholarships. I understand that I will be required to complete various surveys and attend a cultural competency training and awards ceremony. _ Applicant Signature:_Date: *I have read and understand the above outlined scholarship obligations CHC Sponsoring Official Signature (must be human resources director or executive level employee in the applicant s organization): Date: *I have read and understand the above outlined scholarship obligations CCHN, Health Professions Initiative Scholarship Round Five Application Package, Page 7
Health Professions Initiative Scholarship Program Mentorship Survey Colorado Community Health Network (CCHN) is required to formally track the number of mentoring hours each HPI scholarship applicant has received since the applicant became interested in his/her respective health profession. Who Are Your Mentors? Since you became interested in the health profession you are currently pursuing, who have been the people at your Community Health Center and in your community who have served as your mentors? In the space below, please list the names, titles, e-mails, and telephone numbers of the people who have served as your informal and/or formal mentors (please obtain permission from mentors before including their contact information): What Is Mentoring? Informal mentoring can be viewed as conversations about how you can reach your professional goals. You may have someone or several people who have encouraged you to reach your goals by helping you to develop personally and professionally. Formal mentoring can come from your direct supervisor or from others in your clinic or in the community who have helped you to excel in your current position and helped you develop skills to grow into new clinical positions. Since you have been interested in your respective health profession, approximately how many hours have your mentors (please add up all of their time) spent helping you to grow toward your personal and professional goals? Please check one of the following boxes. 0-5 Hours 5-10 Hours 10-15 Hours 15-20 Hours 20+ Hours CCHN, Health Professions Initiative Scholarship Round Five Application Package, Page 8
CCHN Health Professions Initiative Personal Statement Please submit a personal statement outlining: Why you are applying for a scholarship through CCHN s Health Professions Initiative Program. How this program will help you to achieve your professional goals. How you will most benefit from this scholarship program. Your commitment to serving the underserved. A description of your current position at your CHC, a description of your course study of interest, and a statement of how you will advance or have advanced after training (for example: I am a medical records clerk who is attending school to obtain a bachelors of science degree in nursing. Once I complete this program, I will become a registered nurse). An education completion plan (for example: I am currently completing my first semester in the nursing program at the Community College of Denver. I will complete the nursing program in March of 2008). If you have graduated, please specify when you began and finished your health professions training. Note: This statement should be signed and dated and no longer than 2 typed pages in length. Highly desirable applicants are those who are already enrolled and attending a health professions training program, best demonstrate their need for this scholarship, focus on commitment to the underserved, and provide a feasible and well-organized education completion plan. CCHN is committed to obtaining geographic representation from all underserved areas in Colorado. CCHN, Health Professions Initiative Scholarship Round Five Application Package, Page 9
CCHN Health Professions Initiative Scholarship Evaluation Criteria The following is a list of the criteria HPI scholarship application reviewers consider when reviewing HPI scholarship applications. Your application package will be evaluated on: The overall quality of the application. To be considered complete, your application package must include a completed and signed application form, a completed and signed scholarship obligations form, a completed mentorship survey, a signed and dated personal statement, a signed and dated letter of recommendation from one CHC sponsoring official, materials from the training institution of choice, documentation of acceptance and/or enrollment, and the total cost to complete your training. The quality of the personal statement. A quality personal statement must include: Justification for overall need for HPI scholarship assistance. An explanation of how you would advance from this scholarship. An explanation of why you are committed to serving the underserved. A description of your current position at your CHC. A description of your course study of interest. A statement of how you will advance after training. A feasible and well-organized education completion plan. Letter of recommendation. The letter of recommendation must be from a CHC sponsoring official (this may be from your direct supervisor, your human resources director, or another executive level employee at your CHC). The letter of recommendation should indicate strong organizational support for you to receive the HPI scholarship and strong organizational support for your continued employment at the CHC after training. Eligibility criteria. To be considered eligible for the HPI scholarship you must: Be a current CHC employee/volunteer in good standing with the employer and training institution. Have been accepted to a training institution. Have no more than one year of prerequisite courses to complete before entering a health professions training program (If currently completing prerequisite courses). Be requesting a scholarship to be applied to tuition-related expenses or requesting a scholarship to pay back a loan obtained for tuition-related expenses. Be requesting a scholarship for a health professions program that will further you in a health professions career. Be requesting a scholarship for a health professions position that focuses on providing direct clinical care to patients at CHCs. Be requesting a scholarship for a health professions position not higher than a registered nurse (for example, this scholarship cannot be used to support physicians, dentists, psychiatrists, etc). CCHN, Health Professions Initiative Scholarship Round Five Application Package, Page 10
CCHN Health Professions Initiative Scholarship Submission Requirements A completed application form signed and dated by the applicant and the CHC sponsoring official. A completed scholarship obligations form signed and dated by the applicant and the CHC sponsoring official. A completed mentorship survey. A signed and dated personal statement outlining why you are applying for CCHN s Health Professions Initiative program, how it will help you achieve your goals, how you will most benefit from this scholarship program, and your commitment to serving the underserved. A description of your current position, the course study of interest, a statement of how you will advance after training, and an education completion plan should also be included in the personal statement. One letter of recommendation from your CHC sponsoring official (this may be from your direct supervisor, your human resources director, or another executive level employee at your CHC). Materials from your training institution of choice describing the health professions degree/certificate in which you are interested in obtaining (for example: a copy of the program description included in the school s catalogue, etc). Documentation of enrollment in a training institution (for example: a copy of your class schedule, etc). If you are accepted into a health professions program, however not yet attending, please provide documentation of acceptance in the health professions training program (for example: a copy of your acceptance letter, etc). If you are requesting a scholarship to pay back loans for your health professions training, please provide documentation to show the total balance on your loans (from your loan holder) and a copy of your degree/certificate (from your training institution). Documentation of the total cost to complete your training. Please submit your complete scholarship application package including all of the above documents to: Your CHC s HR director. Your CHC s HR director will conduct an initial internal review of the application package to determine eligible applicants and submit qualifying applications to CCHN. If you have any questions, please contact: Amber Galloway, Workforce Development Coordinator, via e-mail at amber@cchn.org or by phone at (303) 861-5165, ext. 234. All applications must be submitted to your CHC s HR Department by Friday, August 3, 2007. Once CCHN has received and reviewed your complete application, Amber Galloway, CCHN s Workforce Development Coordinator, will contact you regarding the status of your application as soon as possible. Scholarship awards are typically decided approximately one month after the application deadline. CCHN, Health Professions Initiative Scholarship Round Five Application Package, Page 11