Education Award Application

PROGRAM OVERVIEW

Purpose:

The Lee Health Education Award Program is designed to encourage current and prospective employees to enter high demand health careers and financially assist those in need.

Background:

Funding for awards is provided by, but not limited to the following resources:

Eloise M. Carlson Educational Grants Cape Coral Hospital Auxiliary Grant

Nathan Family Educational Excellence Grant Lee Memorial Auxiliary Grant

Jim Nathan Endowment Fund Gulf Coast Medical Center Auxiliary

Robert and Frances Feuchter Endowment Lee Memorial Health System Foundation

Edward and Gale McBride Education Scholarship Madeleine R. Taeni Nursing Education Fund

Ellen McDonald Endowed Pediatric Nursing Scholarship (for those who plan to work in Pediatrics at Golisano Children’s Hospital)

Annually, an advisory committee is selected to review the applications received. Each year, the amount of the award may vary, and Lee Health will determine these based on applicant eligibility, funding available, and programs of greatest need or preference.

Eligibility:

·  Awards are based on the applicant’s financial need, academic achievement, work performance (staff and volunteers), and field of study, regardless of the applicant’s race, religion, national origin, ancestry, marital status, sex, age, or disability.

·  Preference may be given to students pursuing or accepted into a field of study in which a shortage exists and/or is listed by the Human Resources Department as a “Critical Need” position.

·  Lee Health employees, their family members, and volunteers may be given preference; however, applicants from the community-at-large will also be considered.

·  Applicants must be residents of Lee, Collier or Charlotte County and attend classes at local schools, colleges, and universities, unless otherwise approved by “exception” by the Grant Advisory Committee.

·  Applications must be submitted between April 1 – May 31 annually. All required forms and documents (see checklist) must be submitted and reviewed prior to May 31. An appointment must be made to review all forms prior to the deadline. New applicant should call 239-424-3525 for appointment. If the applicant received a grant the previous year, an interview is NOT required, but paperwork must be 100% complete and submitted by the May 31 deadline.

·  Due to funding restrictions, requirements for each award may vary and will be considered appropriately. Applicants must meet all eligibility requirements as listed in the criteria.

·  LMHS Employees should be using the Tuition Reimbursement/Advancement to the fullest extent. The Lee Health award cannot be used for the same expenses covered by Tuition Reimbursement/Advancement.

·  Awards must be used for tuition and fees. Personal expenses and books are not covered by these awards. All expenses must be for the academic year beginning Aug 1 and ending July 31 of the following year. Any funds not utilized within said timeframe will be forfeited.

·  Awards are limited to one year, and all applicants must apply annually to be considered. Previous qualification and acceptance is not a guarantee of future awards.

Award Conditions:

·  Award recipients must submit grades within 30 days of completion of each semester, session or course.

·  All applicants agree to work at Lee Health for a minimum of one year (1872 hours) for each year they receive an educational award with a maximum of two years. A “Work Agreement Form” is required upon approval of an award. The work agreement shall start upon placement into a position for which the funds were received. Less than the required annual hours will increase the length of the work agreement.

·  Repayment of the award shall be required for failure to meet the work agreement, failure to complete the program/degree, or for a grade below that required. Non-employees who received education funds will diligently pursue employment with Lee Health upon completion of the degree. If employment is not offered by Lee Health within six months of completion of degree, certification, etc., the grant conditions will be forgiven. The student should thoroughly review the Work Agreement for specific details.

http://www.leememorial.org/jobs/lmhsbenefits.asp (see Education Assistance) or call 239-424-3525.

Criteria:

Awards are available to employees, volunteers and family members, as well as to prospective employees from the community. Monies provided by various funds may contain additional parameters or criteria.

Annual application period is April 1 – May 31. An appointment must be made to submit and review all forms prior to the May 31 deadline (239-424-3525). If the applicant received an award the previous year, the application can be submitted without an interview, however, it must be 100% complete and submitted prior to the deadline. Applications must be complete and will not be accepted after the May 31 deadline.

An annual application is required, as awards are approved for one-year period based on available funds (grades must be submitted from the prior semesters).

Awards are announced in July annually, with check distribution for Fall semester. Funds must be used between August 1 – July 31 of the following year, or the balance returned.

Preference may be given to individuals applying for awards in careers where a shortage exists (i.e., RN ASN, BSN, MSN) Radiology Techs, CNA, CVT, Physical Therapy, Respiratory Care, etc.) A list of Critical Need positions is maintained by Human Resources at Lee Health. Applicants not employed at Lee Health who volunteer at any Lee Health facility, or applicants of family members of Lee Health will receive preference in the approval process.

The amount of the award will be based on financial need (complete “Statement of Finances Form” annually); verification of annual income of self and family must be submitted to establish need. A Pell or other grant or tuition reimbursement will be considered in the amount given, but will not affect the approval of the application. Employees must be using Tuition Reimbursement/Tuition Advancement if they qualify, and may apply for a grant in addition, if they are in financial need for unmet academic expenses. Funds cannot be used for personal expenses or books; limited to tuition and fees.

The applicant must be a resident of Lee, Collier or Charlotte County and attend classes at any of the local colleges or Vocational/Technical Schools, unless approved by “exception” by the Advisory Selection Committee.

Two letters of recommendation are required (forms in application).

A student must be registered for classes prior to receiving grant monies, and must declare if they are taking pre-required courses or have been accepted in an approved course of study in their essay. Proof of acceptance in an accredited program/field of study is required to receive full credit for financial consideration. Vocational/Technical training is exempt and courses will be paid for in advance if application is approved (i.e. CNA, MA, Surgical Tech, etc.).

Applicant must write a one-page essay on career goals, financial need, extracurricular activities, volunteerism; an essay is required for each annual application, and is assessed points toward award approval.

Lee Health employees must submit a letter from their department manager or supervisor that states he/she is currently in good standing (no written counseling in the past 12 months and good job performance is required)

Applicant’s grades must be submitted within 30-days of course/semester completion for which an award was received.

An employment obligation/commitment to work at Lee Health upon completion of training is required; one-year minimum for every year awarded funds (maximum two-year commitment). The Agreement must be signed prior to issuance of monies.

Repayment of the award will be required if the recipient fails to meet the work obligation, drops or fails course, etc. A minimum of “C” is required for college level courses, and if grade is pass/fail, only pass will be accepted.

For Lee Health employees, volunteers and their families: These individuals may receive preference for available funds, and the award can be used for tuition, testing, or other related educational expenses not covered by tuition reimbursement or other funding. Funds used for other than education are taxable income to the student. Grant checks are issued payable to the school.

For non-employees: The award can only be used for tuition, lab fees or tests, and the check will be payable directly to the school indicated on the application.

The maximum range of the grant per year is determined annually based on funds and applications. Pre-requisite courses are limited to a range of $500-$800.

Please choose from the following:
Lee Health Employee,
(Employee Number__ ___) / Lee Health Volunteer
(Volunteer Number___ __)
Lee Health Employee Family Member / Prospective Employee

Previously awarded any of these Grants? Yes No Year(s):

PART I. Personal Data (print legibly)

Applicant’s Name: / Email:
Permanent Address:
City: / State: / Zip:
Phone (H): / (W): / Cell:
Social Security Number: / U.S. Citizen: Yes No
Are you a resident of Charlotte, Lee or Collier County: Yes No

PART II. School Information

High School Attended Graduation Date:
University / College you will be attending: Full Time Part Time
Field of Study: / Accepted in program? Yes No Pending
Projected Graduation Date: Year in College 1 2 3 4
Currently taking pre-required classes prior to acceptance in field of study? Yes No GPA:
Student ID #:
Do you plan to work in Pediatrics? Yes No

PART III. Employment Information

Currently employed: Yes NoIf Yes, Full Time Part Time PRN
Employer: / How Long? Yr. Mo.
Position: / Do you plan to work while attending school? Yes No
Lee Health Department / Location: / Date of Hire:

PART IV. Parental and Family Information

Are you claimed as a dependent? Yes NoIf Yes, who?
Are you living in your own home or apartment? Yes No
Number of family members currently living in your household: (include yourself, parents, other children and legal dependents)
Do you have any legal dependents (other than spouse)? Yes No
If you have any dependents, other than spouse, how many in each of the following age groups?
0-5: 6-12: 13+: Elderly parents:

PART V. Community Service

Have you volunteered with Lee Health? Yes No
If yes, when: Number of hours volunteered?
Which facility(s):
Other Organization and Event participated in:

Linked to Policy S09 04 209

PART VI. Use the below Checklist to ensure that all required information is submitted to be considered for this grant:

Completed Application and associated documents (be sure to include all of the following upon submission)
An Essay is required with each annual request (no longer than 500 words) explaining your career goals, pertinent background information, why assistance is desired, how funds will be used, field of study, volunteer and/or community and extracurricular activities, etc.
Two Professional Recommendations from sources such as instructor/teacher, current or past employer/manager or guidance counselor concerning your potential to succeed.
Documentation that you are registered and have been accepted in an approved school or college/field of study. (Must be received prior to check issue Aug. 1 and match your application)
Transcript from past or present schools; re-application requires proof of passing all previous classes taken.
If you are an employee or volunteer at Lee Health, a signed letter of recommendation from your manager or an email sent to stating that you are in good standing, with zero corrective actions (corrective actions over the past year will disqualify the applicant), will be accepted as one of the two recommendations needed.
“Statement of Finances” completed and signed.
Copy of the your most current tax return (this will be kept confidential); first two pages are adequate with signatures. If applicant can be claimed as an exemption on parent’s taxes, please indicate this. Taxes of parents are optional, but not providing them to establish financial need may result in a lower approved grant. All tax documents are destroyed after committee reviews applications and selects recipients.

New Applicants: Application and documents must be submitted in person at the time of an interview – please call (239) 424-3525 to schedule an appointment to review your completed application from April 1 – May 31. Late applications will not be accepted. Plan 2-3 weeks ahead to schedule an interview.

Renewal (Previous) Applicants – Please submit your application between April 1 and May 31. An interview is not required, unless you prefer to meet with a reviewer. It is suggested that applications be submitted as early as possible before the May 31 deadline.

I certify that the material submitted by me is true and correct without omissions of any kind. I understand that a work agreement will be required for all approved awards as stated in the policy. I further understand that if this award is approved, any false statements, answers or omissions shall be considered sufficient cause for termination of the award and will require repayment to Lee Health.

Applicant Signature: ______Date: ______

FM# 0846 Rev. 03/16 Page 4 of 8

Education Award Application

STATEMENT OF FINANCES

Current or Previous Annual Income:

What was your (and spouse’s) adjusted gross income for the previous year. Adjusted gross income is on IRS Form 1040 – line 37; 1040A – line 21; or 1040EZ – line 4.

TOTAL: $______(annual)

PART I

Anticipated Annual Education Expenses (August 1 – July 31):

Tuition (based on the number of courses or credit hours x cost/Cr. hour) $______

Books $______

Fees $______

Supplies List: ______

______

______$______

(Annual Education Expenses) GRAND TOTAL $ ______

PART II. Anticipated financial assistance with school expenses:

Source: Bright Futures, Pell/FAFSA, etc.______$______

Tuition Reimbursement/ Lee Health employees (annual amount allowed) $______

TOTAL: ...... ……… $______

Note: A Pell grant, present or future, or other financial resources received, does not disqualify you from receiving additional funds, as financial assistance is based on a student’s needs.

Lee Health employees should be using Tuition Reimbursement/Advancement to the fullest extent before submitting an application. Tuition reimbursement and the Award received cannot be used for the same expenses incurred. Funds approved, are for tuition, and fees only.