BOZEMAN HEATH HEALTHCARE PROFESSIONALS’ SCHOLARSHIP APPLICATION The Bozeman Heath Healthcare Professionals’ Scholarship is intended for Gallatin, Madison and Park high school students who are interested in pursuing health science degrees for a career in healthcare to assist in obtaining post‐high school education. Bozeman Heath awards the following scholarships annually to Gallatin, Madison and Park County high schools students who are pursuing studies in a health‐related field. Four health career scholarships will be awarded each year. Each scholarship is for $1000 per year and is renewable each year for three additional/consecutive years as long as the student remains in a health‐related program. In addition, the student must continuously remain in good standing with a 3.0 GPA or higher. The scholarship is limited to four years. A.
Four scholarships: Each scholarship is for $1000 per year and is renewable each year the student remains in a
health‐related program in good standing, with a 3.0 GPA or higher. The scholarship is limited to four years of
undergraduate or graduate school.
CRITERIA: Applicants who will be considered for these scholarships shall:
1.
2.
Be a U.S. citizen/permanent resident and provide proof of citizenship/permanent residency with application.
Be a resident of Gallatin, Madison or Park County and attending one of the following schools:
a. Belgrade High School
l. Manhattan Christian School
b. Big Sky Discovery Academy
m. Manhattan High School
c. Bozeman Christian School
n. Park High School
d. Bozeman High
o. Petra Academy
e. Bridger Alternative
p. Sheridan High School
f. Ennis High School
q. Shields Valley High School
g. Gardiner High School
r. Three Forks High School
h. Harrison Public School
s. Twin Bridges School
i. Henry Wadsworth Longfellow Academy
t. West Yellowstone High School
j. Heritage Christian School
u. Willow Creek School
k. Lone Peak High School
3.
4.
Be 19 years of age or younger as of December 31st of the year in which they apply for the scholarship.
Have been accepted by an accredited school, college or university offering an associate’s degree, bachelor’s degree
or high degree program in a health‐related field.
Be a full‐time student.
Submit an official high school or current college transcript with application.
Submit current letters of recommendation, one each, from three of the following:
a. Director of a Volunteer Services program
b. Employer
c. Counselor/Advisor
d. Teacher
Submit by March 18th a completed application with all of the above criteria met.
5.
6.
7.
8.
Recipients of the awards will be notified in late May. Upon verification of enrollment, a check in the amount of $1,000.00 will be sent to the Financial Aid office of the recipient’s school. 1
BOZEMAN HEATH HEALTHCARE PROFESSIONALS’ SCHOLARSHIP APPLICATION All information submitted with this application is confidential. Please print or type. PERSONAL DATA Name (Mr. Mrs. Ms. Miss) U.S. Citizen Last 4 digits of Social Security # Yes No Age Birthdate
EMAIL address: ______________________ Current Address: City State Zip Phone ( ) Father’s Name Fax ( ) Occupation Address City State Zip Mother’s Name If married, Spouse’s Name ) Fax ( ) Phone ( ) Fax ( ) Occupation Address City Phone ( State Zip Occupation 2
BOZEMAN HEATH HEALTHCARE PROFESSIONALS’ SCHOLARSHIP APPLICATION EDUCATIONAL BACKGROUND Name of High School Address City State Zip Phone ( ) Fax ( ) SCHOOL ACTIVITIES / AWARDS Please list awards, honors, scholarships received, and activities participated in for the last two (2) years. Prior years may be listed on a separate sheet of paper. Other activities and offices held (High School, College, Community Clubs) WORK EXPERIENCE (other than volunteer) List all work experience in which you have participated, whether related to health care or not. Employer
Job Title or Duties
Dates 3
BOZEMAN HEATH HEALTHCARE PROFESSIONALS’ SCHOLARSHIP APPLICATION PROFILE OF THE APPLICANT (Educational and Career Goals) Scholastic standing GPA Name of school planning to attend in the fall Major Minor area of specialization What living arrangements will you have at school? What health career do you plan to pursue? What qualifications do you feel you have to pursue a health care career (100 words or less). Education and occupational goals as they relate to the health care industry (100 words or less) 4
BOZEMAN HEATH HEALTHCARE PROFESSIONALS’ SCHOLARSHIP APPLICATION VOLUNTEER ACTIVITIES / SERVICES Community Healthcare‐Related Volunteer Services: Name of agency or institution Supervisor Phone ( ) Fax ( ) Address Total hours Hours during the last 2 years Name of agency or institution Supervisor Phone ( ) Fax ( ) Address Total hours Hours during the last 2 years Community‐Related Volunteer Services Name of agency or institution Supervisor Phone ( ) Fax ( ) Address Total hours Hours during the last 2 years Name of agency or institution Supervisor Phone ( ) Fax ( ) Address Total hours Hours during the last 2 years 5
BOZEMAN HEATH HEALTHCARE PROFESSIONALS’ SCHOLARSHIP APPLICATION CONSENT FOR RELEASE OF INFORMATION “I hereby consent to the release of any information in connection with the foregoing that in the sole judgment of Bozeman Health may be of assistance in evaluating my scholarship application. I hereby waive any confidentiality with respect to such information insofar as Bozeman Health is concerned, since it is my understanding that the information will be used solely for the evaluation of my application for scholarship and for no other purpose.” Signature of applicant Date completed RETURN COMPLETED APPLICATION BY MARCH 18TH TO: BOZEMAN HEATH HEALTHCARE PROFESSIONALS’ SCHOLARSHIP APPLICATION c/o Health Information Center 915 Highland Blvd Bozeman, MT 59715 Attention: Scholarship Chairman Please note: It is the applicant’s sole responsibility to see that the completed application, official transcripts, and letters of recommendation are received by the Bozeman Health Scholarship Committee by March 18th. 6