“Making A Difference” Underclassman Scholarship Program 2017-2018

  1. The North Texas Latin American Physicians Association (NTLAPA) and NTLAPA Charitable Foundation (NCF)are local non-profit organizations of Physician and Professional Healthcare Leaders working together to improve the quality of healthcare for the communities in North Texas through scholarship and community support.
  2. DEADLINE for scholarship applications is May 31st, 2017. (No exceptions).
  3. Refer to application process below for eligibility requirements and a list of the supporting documents needed (i.e., reference forms, evidence of GPA, etc.) Incomplete applications will not be considered.
  4. If any question does not apply to you in this application please put N/A in the space.
  5. Type or print legibly. Illegible applications will be returned to you. You may also download a copy of the application online at .
  6. You will be notified by mail on or about June 30th, 2017 regarding the status of your application.
  7. If you have any questions about the application, please call the NTLAPA/NCF office at (214) 457-9378 or email us at (Dr. Raymond Munoz, Scholarship Committee Chairman or Dr. James Chanez NTLAPA/NCF President).

Purpose: To provide scholarships for up to six (six) deserving Latin-American graduating high school or current underclassman college students from (or new to) the North Texas Region seeking a healthcare professionespecially in medicine. (See full criteria below) (NOTE: North Texas Region area includes the following counties: Collin, Dallas, Denton, Ellis, Franklin, Erath, Hood, Hunt, Grayson, Johnson, Kaufman, Navarro, Palo Pinto, Parker, Red River, Rockwall, Somervell, Tarrant, and Wise).If you feel you are eligible for other geographical reasons, please contact us.

Award Components: Up to six (6) $500 scholarships and individual certificates awarded to up to six (6)incoming or current underclassman college students selected by the NTLAPA/NCF Scholarship Committeeseeking a healthcare profession in medicine.

Criteria:

  1. Applicant must be: a) an underclassman college student already enrolled at an accredited North Texas university/college in the 2017-2018fall school year, or b) a graduating high school senior from the North Texas Region (see above for area criteria) who will be enrolled in an accredited university/college in North Texas in the 2016-2017fall school year.
  2. You or your family (parents, grandparents) must be descended from at least one of the following countries: Spain, Mexico, Guatemala, Honduras, El Salvador, Costa Rica, Nicaragua, Panama, Colombia, Venezuela, Ecuador, Peru, Argentina, Chile, Bolivia, Uruguay, Paraguay, Cuba, Puerto Rico, or the Dominican Republic. Students from Brazil are eligible to apply. However, if you feel you are eligible for other reasons, please contact us.
  3. Applicant must demonstrate positive-impact involvement consistent with capacity and circumstances and/or significant improvement/success in scholarship and community involvement, determined through letters of recommendation.
  4. Scholarship can only be won twice (2) by same student.

Application Process:

Applicant must submit the following items:

  1. Completed application form (if handwritten, please print legibly)
  2. Letter of Application (Personal Letter) addressed to the NTLAPA/NCFScholarship Committee. The letter should contain a very brief explanation of career goals and biographical (background) information.
  3. Two (2) letters of recommendations from choice of professors/teachers, administrators, counselors, employers, or professional individual with significant knowledge of applicant’s experience and involvement.
  4. Direct from your school, a Summary Profile Sheet and Record of High School/College Work or an official recent college or High School transcript with cumulative GPA and a class standing/rank.
  5. Personal Essay. In your essay, please answer the question on the enclosed essay form.

How have you made a positive difference?

Deadlinefor the application is May 31st, 2017. Applications postmarked after this date will not be considered.

Please mail form to:

“Making a Difference” Underclassman Scholarship Program

NTLAPA/NCF

8230 Walnut Hill LN., Ste. 804

Dallas, Texas 75231

“Making a Difference” Underclassman Scholarship

Application 2017-2018

Please type or print your answers. If application is illegible, it will not be accepted.
1. / Last Name: / First Name:
2. / Current Mailing Address:

Street: ______City: ______State: _____ZIP: ______

Email:______
3. / Daytime Telephone Number: ( ) -
4. / Date of Birth: Month Day Year
5. /

Current High School or College:

/ Number of years attended:
6. / I will be attending the following College/University in the Fall of 2017: ______
Proof of acceptance or current student enrollment from the above school is required prior to receipt of funds.
7. / I will be entering the above-mentioned school as a: (Circle one)
Freshman Sophomore Junior Senior
8. / Grade Point Average (GPA): ______(On a 4.0 scale) Rank if known:______
Direct from your school, a Summary Profile Sheet and Record of College Work or attach proof of GPA and most recent official school transcript.
9. / SAT Score:______
Send Official SAT score transcript.
10. /

Name & address of parent(s) or legal guardian(s): Use reverse side of application if you need more space.

Name (s)
______
Street: ______City:______State: ______ZIP:______
Home phone of parents or legal guardians:______
11. / Hispanic/Latin Background:______/ Parents or Grandparents Latin Birth Country:
12. / List the name of all High Schools and College(s) you have or will attended. / Year
Began / Year
Ended / Year
Graduated
(If applicable) / Type of Degree
Received
(If applicable)
A.
B.
C.
13. / What specialty/fellowship do you plan to accomplish as you continue your post medical school education?
14. / List expenses you expect to incur in 2017-2018 per semester or quarter: (Approximate figures acceptable)
You may get an official expense report from your Financial Aid Office.
A. / Tuition: Amount: $
B. / Books: Amount: $
C. / Room & Board: Amount: $
D. / Other expenses: Amount: $ Describe below under comments
E. / Other expenses: Amount: $ “
Comments:
15. / List other financial assistance you will receive per semester or quarter:
You may get an official financial assistance report from your Financial Aid Office.
A. / Personal: Amount: $
B. / Other Scholarship(s): Amount: $ Describe below under comments
C. / Grants: Amount: $ “
C. / Student Loan(s): Amount: $ “
D. / Other Financial Resources: Amount: $ “
Comments:

Use an additional sheet if you need more room to list financial information requested in items 14 & 15.

16. / What are your educational and professional goals and objectives?
17. / List your academic honors, awards and membership activities while in high school or college:
18. / List your community service activities, hobbies, outside interests, and extracurricular activities:

“Making a Difference” Underclassman Scholarship

Application 2017-2018

19. / Personal Essay
Please answer the following question:
How have you worked in your life to make a positive difference?
Submit your response on the last sheet provided with this application.
20. / A. The following items below along with a very brief Personal Letter must be attached to this application in order for the application to qualify to be reviewed by the scholarship committee.
B. Your application will be returned to you if these items are not attached to this application. (No exceptions.)
C. Circle “YES” or “NO” to be sure you have attached each item as required.
YES / NO / Two (2) recommendationletters. Return these completed letters in a sealed envelope from your teachers or professors.
YES / NO / Proof of college acceptance or current college student enrollment. A letter of college acceptance or program acceptance is required for receipt of funds.
YES / NO / Direct from your school, a Summary Profile Sheet and Record of College Work (give NTLAPA/NCF approval to receive with signature) or a Most recent official college and/or officialhigh school transcript. Photocopies of your transcript are not acceptable.
YES / NO / Personal Essay. How have you made a positive difference in your community, school, family, etc.?

STATEMENT OF ACCURACY and CONSENT

I hereby affirm that all the above stated information provided by me is true and correct to the best of my knowledge. I also consent that my name and picturescan be used for any purpose deemed necessary to promote NTLAPA/NCF’s Underclassman Scholarship Program and/or the NTLAPA/NCF nonprofit organizations. I will also fill out a “follow up questionnaire” in the future in regards to my scholarship and how I used the money.

I hereby understand that if chosen as a scholarship winner, according to NTLAPA/NCF Scholarship policy, I must provide evidence of enrollment at an accredited university/college before scholarship funds can be awarded.

With your signature, you also give NTLAPA/NCF permission to receive your Summary Profile Sheet and Record of College or High School Work or Official transcript from your school.

Signature of scholarship applicant: ______Date: ______

REMEMBER

The deadline for this application to be received by NTLAPA is May 31st, 2017. No exceptions!

Please mail form to:

“Making a Difference” Underclassman Scholarship Program

NTLAPA/NCF

8230 Walnut Hill LN., Ste. 804

Dallas, Texas 75231

“Making a Difference” Underclassman Scholarship

Application 2017-2018

Personal Essay

How have you made a positive difference?

1