Effingham Health System Auxiliary Scholarship Fund
Application must be submitted with all documentation by April 14, 2015.
Year 2015-2016
The award amount is $500.
Turn in completed application to: High School Counselors Office
Remember to meet these qualifications
and turn in all paperwork with your application.
o Have a 3.0 GPA
o Include a letter of acceptance from a college (or copy of your application) offering a program of study leading to a medical career. Keep your original acceptance letter and provide a copy only.)
o You can apply if you plan to go to a technical school, 2 year or 4 year school, are at least a high school senior or in college.
o Write an autobiographical sketch including your plans for a health field career.
o Submit a photograph of any size.
o Must be a resident of Effingham County.
o Include three written letters of recommendation. Recommendations must be in a sealed envelope and cannot be from personal friends.
o Show evidence of financial need in pursuance of a career in the medical field. List income from all sources in your household.
o Include an official high school transcript or college transcript, if applicant is in college. Transcripts must be in a sealed envelope.
Please note that scholarship funds for the recipient will be disbursed
to the chosen college or institution and not to the applicant.
Effingham Health System Auxiliary Scholarship Application
2015-2016
Personal Information:
Full Name______
Social Security Number______Birth Date______
Home Address______
City______Zip______
Telephone______E-mail______
Marital Status______Spouse Name______
Dependents (Name, Age, Relationship)______
______
What college do you plan to attend______
(Name) (Location)
Education Information:
What is your professional goal?______
What is your course of study? Present academic level?______
What is your cumulative grade point average?______
Will you attend school___Full Time___Part Time / Expected Graduation Date______If part time, specifically what else will you be doing?______
______
Degrees or Diplomas Granted:______
______
What Honors (academic or otherwise) have you received and when:
______
______
What sports have you participated in:______
______
Occupational Information:
In what health or science related fields or activities have you been involved in for recreation, as a volunteer, or as an employee?______
______
______
______
______
List all jobs you have held and indicated whether they were full time or part time. Paid work and volunteer work should be listed.
Employer What kind of work did you do? Dates
______
______
______
______
Confidential Information: Income information for person(s) responsible for school expenses.
Father’s Name______
Employment______
(Company) (Address)
Occupation and Approximate Income______
Mother’s Name______
Place of Employment______
(Company) (Address)
Occupation and Approximate Income______
Place of employment______
Number and Age of Siblings______
How many in school?______How many in college?______
Do you contribute to the support of any other person(s) or have other financial obligations?______
______
Student Certification:
I declare that the information reported is true, correct and complete.
Signature______Date______
Scholarship Agreement:
It is agreed that:
1. The decision of the Scholarship Committee’s award is final.
2. Further personal and/or financial information will be provided to the committee if requested.
3. Scholarship funding is to defray cost of tuition and is paid to the Georgia School of your choice.
4. In the event the student does not start school or ceases course of study in related health field, the scholarship funding will not apply and therefore the award will not be paid.
I have read and clearly understand the above agreement.
This, the ______Day of ______, 20____.
Student Signature______
Parent(s) or Guardian(s) Signature______
The deadline for this application and all documentation is April 14, 2015.
Barbara K. Tumperi Scholarship
Georgia Hospital Association/Council of Auxiliaries/Volunteers
Application must be submitted with all documentation by April 10, 2015.
Year 2015-2016
The award amount is $1000.
Turn in completed application to: High School Counselors Office
Remember to meet these qualifications and turn in all paperwork with your application.
o Have a 3.0 GPA
o Include a letter of acceptance from a college (or copy of your application) offering a program of study leading to a medical career. Keep your original acceptance letter and provide a copy only.)
o You can apply if you plan to go to a technical school, 2 year or 4 year school, are at least a high school senior or in college.
o Write an autobiographical sketch including your plans for a health field career.
o Submit a photograph of any size.
o Must be a resident of Effingham County.
o Include three written letters of recommendation. Recommendations must be in a sealed envelop. Letters from personal friends are not accepted.
o Show evidence of financial need in pursuance of a career in the medical field. List income from all sources in your household.
o Include an official high school transcript or college transcript, if applicant is in college. Transcripts must be in a sealed envelope.
Awards will be based on the applicant’s:
ü Scholastic records
ü Character
ü Qualities of leadership
ü Participation in student and community activities
ü Cooperation with school authorities
Please note that scholarship funds for the recipient will be disbursed
to the chosen college or institution and not to the applicant.
Barbara K. Tumperi Scholarship Application
Personal Information:
Full Name______
Social Security Number______Birth Date______
Home Address______
City______Zip______
Telephone______Email______
Marital Status______Spouse Name______
Dependents (Name, Age, Relationship)______
______
What college do you plan to attend______
(Name) (Location)
Education Information:
What is your professional goal?______
What is your course of study? Present academic level?______
What is your cumulative grade point average?______
What school will you attend this next fall?______
Will you attend school__Full Time___Part Time / Expected Graduation Date_____
If part time, specifically what else will you be doing?______
______
Degrees or Diplomas Granted:______
______
______
What Honors (academic or otherwise) have you received and when:______
______
______
______
Tumperi Scholarship - Page 2
Occupational Information:
In what health or science related fields or activities have you been involved in for recreation, as a volunteer, or as an employee?______
______
______
______
______
List all jobs you have held and indicated whether they were full time or part time. Paid work and volunteer work should be listed.
Employer What kind of work did you do? Dates
______
______
______
______
______
Confidential Information: Income from all sources in household must be listed.
Information for person(s) responsible for education expenses.
Father’s Name______
Place of Employment______
(Company) (Address)
Occupation and Approximate Income______
Mother’s Name______
Place of Employment______
(Company) (Address)
Occupation and Approximate Income______
Place of Employment______
Number and Age of Siblings______
How many in school?______How many in college?______
Do you contribute to the support of any other person(s) or have other financial obligations?______
______
______Tumperi Scholarship – Page 3
Student Certification:
I declare that the information reported is true, correct and complete.
Signature______Date______
Scholarship Agreement:
It is agreed that:
1. The decision of the Scholarship Committee’s award is final.
2. Further personal and/or financial information will be provided to the committee if requested.
3. Scholarship funding is to defray cost of tuition and is paid to the Georgia School of your choice.
4. In the event the student does not start school or ceases course of study in related health field, the scholarship funding will not apply and therefore the award will not be paid.
I have read and clearly understand the above agreement.
This, the ______Day of ______, 20____.
Student Signature______
Parent(s) or Guardian(s) Signature______
Do Not Write Below This Line
======
Name of Sponsoring Auxiliary:
Effingham Health System Auxiliary/Southeast
Name of Scholarship Chairman__Rosemary Alexander______
Telephone Number of Scholarship Chairman_____(912) 604-9616______
Home Mailing Address_____110 Laurel Pointe Drive, Springfield, GA 31329__
E-mail ______
Date______
The deadline for this application and all documentation is April 14, 2015.