Foundation Scholarship Overview
BUCCI SCHOLARSHIP
The Bucci Scholarship Fund was established in 2012, in honor of Leona Bucci, when she retired as Director of Hospice. Awards from this scholarship are given to students seeking an accredited degree in the field of nursing (LPN, RN, or BSN). Special consideration is given to a student who has an interest in working in the palliative care field upon graduation.
D’AMORE SCHOLARSHIP
The Dr. Marty D’Amore Scholarship Fund was established in 2015 following the death of Dr. D’Amore after a long battle with ALS (Amyotrophic Lateral Sclerosis). The fund was created and supported by donations from physicians and the medical community. Awards from this scholarship are given to students accepted or enrolled in an accredited Radiology Sciences program.
HUDSON SCHOLARSHIP
Mr. and Mrs. Hudson established the Mr. and Mrs. Joe R. Hudson Nursing Scholarship in 1974. Awards from this scholarship loan program are given based on organizational needs, scholastics and acceptance into nursing programs for area students. It does not include preparatory courses prior to acceptance into discipline-specific programs. Recipients are required to sign a promissory note that they intend to apply to become an employee of CaroMont Health after completing their studies or remain an employee and agree to work full-time, one year for each school year of participation in this program, after graduating. If they do not complete their studies, accept an offered position with CaroMont Health or fulfill their work obligation, they are required to pay back the total amount or a prorated amount of their award within 30 days.
MACKIE SCHOLARSHIP
The H. Spurgeon Mackie, Jr. Scholarship was established in 2006, in honor of Spurgeon Mackie upon his retirement from Wachovia Bank. Awards from this scholarship program are given to students majoring in nursing and/or allied health professions. Applicants must be enrolled in or accepted for enrollment in an accredited nursing or allied health program.
WAGGONER SCHOLARSHIP
The Lonnie and Rachel Waggoner Nursing scholarship is a permanent endowment established in 2005, to honor the professional and community service contributions of Dr. and Mrs. Lonnie Waggoner. It is funded by gifts from friends and professional associates. Awards from this scholarship are given to students seeking an accredited degree in the field of nursing (LPN, RN, or BSN). Applicants must be enrolled or in accepted for enrollment in an accredited nursing program.
Applications for all general scholarships will be available on the CaroMont Health website on the Foundation page. The application deadline is February 27, 2017.
Scholarship Guidelines, Process, and Timeline
The CaroMont Health Foundation is thrilled to be able to offer scholarship assistance to individuals seeking degrees in health-related majors.
Applicant Criteria:
· Scholastic Achievement- proof of cumulative 3.0 grade point average for previous academic performance
· Financial need
· Evidence of student leadership and community service
· Passion for the healthcare profession
· Residency in CaroMont Health service area, or relationship to CaroMont Health employee
Required Information:
All information below is required and must be received by the Foundation office on or before the stated deadline.
1. Completed application
2. Resume, including extracurricular activities, leadership and volunteerism listing – with years of involvement
3. Most recent official academic transcript
4. Proof of application or attendance at an accredited college or university healthcare program. Scholarship funding will not be released until proof of acceptance is provided.
5. Two (2) completed reference forms
6. Recent photo
Submit all documentation to the following:
CaroMont Health Foundation
Sandra Kelly
2525 Court Drive
Gastonia, NC 28054
Application deadline is 5:00 PM on Monday, February 27, 2017. Incomplete applications or applications received after this date will not be considered.
For more information, please contact Sandra Kelly at 704.834.4034 or .
Scholarship Application
Please check the scholarship(s) for which you are applying
Bucci ________ Hudson _______ Mackie ______ D’Amore ________ Waggoner _______
Name: Phone:
Physical Address:
Contact E-mail: Parents’ E-mail:
(if applicant is a minor)
Mailing Address: (if different)
Parents’ names: (if applicant is a minor)
Father’s employer: (if applicant is a minor)
Mother’s employer: (if applicant is a minor)
Association with CaroMont Health
Current Employee: Yes No # of years employed Current Volunteer: Yes No
Department: Supervisor: Phone:
Family Member of Employee: Yes No Family Member of Volunteer: Yes No
Employee/Volunteer‘s Name:
Department: Supervisor: Phone:
Relationship to applicant:
Last educational institution attended (high school or college)
Name of School: City/State: Year Completed:
What is your intended major?
What are your future career plans?
What college are you currently attending or planning to attend during the next academic year? If you have not made a final decision, to what colleges have you already received acceptance?
List other scholarships/grants for which you have applied or have been awarded and the amount of each scholarship/grant.
Financial Analysis:
Range of combined total annual household income from all sources:
(Minors: please use parent/guardian)
Under $19,999 _______________ $50,000 - $79,000 _________________
$20,000 – $49,999 ____________ More than $80,000 _________________
Please explain your financial need, along with any unusual circumstances:
Essay Question: Please attach a typed essay in response to the following essay question. Please limit your response to 350 words.
What makes you a qualified applicant for CaroMont Health Foundation Scholarships? In addition to financial assistance, how would this scholarship help facilitate or further your pursuit of a healthcare career?
I certify that all information given in this application is true and complete to the best of my knowledge. In submitting this application, I authorize investigation of all statements contained herein, and it is understood and agreed that any misrepresentation by me in the application will be sufficient cause for cancellation of this application. I authorize CaroMont Health Foundation to make any investigation deemed necessary and release the party contacted from all liabilities and damages for issuing same.
Applicant Signature: ______________________________________ Date: __________________
Parent/legal guardian Signature: ____________________________ Date: ________________ (If applicant is under 18)
Personal Reference Form
To be completed by applicant: (Please print)
1. Applicant’s Name: _______________________________________________________
(Last) (First) (Middle)
2. Admitted/Applied to Health Career Program at: _________________________________
(school)
3. Under the provisions of the Family Educational Rights and Privacy Act of 1974, you may decide whether references completed at your request are to be held confidential or whether they are to be available for your personal inspection. Check one of the following statements and place your signature in the space provided so that the reference will be advised of your choice.
________ Confidential File. I grant permission for completed references to be held confidential by The CaroMont Health Foundation.
________ Open File. I retain the choice of having completed references available to me.
______________________________________________________________________
Applicant Signature Date
Applicant Name: ____________________________________________
To be completed by reference:
You may wish to make additional comments in a letter. If you do so, please attach your letter to this form. Please return this form to the applicant (no later than February 16) in a sealed envelope with your signature on the back flap.
Questionnaire
1. Knowledge of applicant:
________ This student has been enrolled in my class(es).
________ I was this student’s major professor or academic advisor.
________ While I have not taught or advised the applicant, I have known this person for
_______ year(s).
2. Scholastic Evaluation: In comparison with other students in the same academic area, I rate this applicant:
________ Superior (upper 5%) ________Average (upper 50%)
________ Very Good (upper 10%) ________ Below Average
________ Good (upper 25%)
3. Recommendation: Considering this applicant’s academic record, special abilities, ambition and determination, please indicate your level of recommendation of this applicant.
Academic Special Ambition &
Record Abilities Determination
I recommend strongly for: __________ ________ __________
I recommend for: __________ ________ __________
I recommend with reservation: __________ ________ __________
I cannot recommend for: __________ ________ __________
4. Please state reasons for your assessment of the applicant’s qualifications.
Name of Reference: ________________________________________________________(please print)
Phone: Home: ___________________________Other: ________________________________________
Title: ______________________________Institution (if applicable): ____________________________
Address: ____________________________________________________________________________
Signature: _______________________________________Date:________________________________
News Release Permit
Scholarship Applicant
I hereby authorize CaroMont Health to release news information and/or photographs of me to the
news media.
I agree to hold CaroMont Health free of liability and harmless for any action arising from the use or publication of these photographs and/or news information.
_______________________________________________
Print full name
_______________________________________________
Signature
_______________________________________________
Date
_______________________________________________
Please print full name of parents, guardian or spouse (as appropriate)
Please attach photo here:
(print name on back of photo)
7