SkyLakes Cancer Advisory Committee Scholarship
SkyLakes Cancer Advisory Committee
Scholarship Application
This scholarship is available to any graduate of a KlamathCounty or KlamathBasin high school who has completed a four-year course in any public or private school within the County or Basin or who has been an employee of SkyLakesMedicalCenter for a minimum of three (3) years. The award is restricted to students enrolled in a health occupation program at Oregon Institute of Technology, OHSU School of Nursing at OIT and Klamath Community College and can be used in any term needed. Priority will be given to students pursuing a program with an emphasis in oncology or related area, but all students heading toward a health career are encouraged to attend. The scholarship may be used for any school-related expenses such as tuition, books, lab fees, etc. The Scholarship committee will consider only applicants with a cumulative G.P.A. of at least 2.5 or equivalent. Applicants may be invited to meet with the review committee for an interview. The scholarship is awarded annually and must be applied for each year. SkyLakes’ employees pursuing advanced training in oncology are encouraged to apply for this scholarship.
Copies of this application blank may be procured by sending a stamped self-addressed envelope to:
SkyLakesMedicalCenter Foundation
2865 Daggett Avenue
Klamath Falls, Oregon97601
- Instructions: Mail or deliver the following items by midnight Friday, February,21, 2014to:
SkyLakesMedicalCenter Foundation
2865 Daggett Avenue
Klamath Falls, Oregon97601
- This completed application form.
- An official transcript of your most recent school and/or college record.
- A 300-500 word essay about yourself, including hobbies, plans and aspirations, factors which have favorably or adversely influenced your life, health, reason for desiring to attend the school or college you have chosen, and any other information about yourself which you think pertinent. Please type if possible.
- Three completed recommendation forms (attached) from individuals who know you well. These may include a businessperson, minister, professor under whom you have taken courses, or present employer.
- Mail all items in a single packet. The recommendation forms should be in sealed envelopes so that they may be confidential.
- Name of Applicant
LastFirstMiddle
- Date of Birth
MonthYear
- If applicable, applicant’s CurrentSchool
School Address
- Applicant’s Home Address
- Applicant’s Telephone Number
- ListHigh Schools and Colleges you have attended:
School or CollegeLocationDates Attended
- Name of School or College you plan to attend next year
Have you been accepted at this school/college? YesNo
Will you be attendingPart-timeFull-time.
What month and quarter or semester will you start classes?
- If you will be attending part-time, please explain:
- If you are transferring from your present school or college, please state reason. Use additional pages if needed.
- From which school or college do you plan to graduate?
- List special honors, prizes or scholarships you have received for academic work during your last two years in high school and in college (use additional pages if needed):
- Describe your work experience (part-time, full-time and vacation periods.) List employers and duration of employment (use additional pages if needed):
EmployerJob Title/DescriptionDates Worked
- Tell us why are you interested in entering your chosen field in an essay of 350-500 words? (Use additional pages if needed.)
- List activities in which you have taken part during the last two years of high school or in college. Mention any special recognition received or offices held. Use additional pages if needed.
High School
College
Community or Church Organizations
- Other comments. Use additional pages if needed.
- Date
- Signature of Applicant
SkyLakes Cancer Advisory Committee Scholarship
Reference Form
Thank you for taking the time to complete this Reference Form for the Sky Lakes Cancer Advisory Committee Scholarship review committee. The student who asked you to fill in this form is applying for a scholarship to pursue studies toward a career in the health industry with a possible emphasis in the field of oncology. Along with a strong academic background, the committee looks for students with skills that will enable him or her to work well with patients and with fellow healthcare workers.
Please answer the following using this scoring scale:
1=This person demonstrates very little of this characteristic and will need significant development.
2=This person has some of this characteristic but lacks depth in many of the criteria.
3=This person demonstrates a slightly less than average to average amount of this characteristic.
4=This person demonstrates an average to slightly better than average amount of this characteristic.
5=This person has significant strength in this characteristic.
6=This person demonstrates an exceptional level in this characteristic and is a role model.
Student’s Name: ______
Attitude:
Is courteous and cordial to fellow students, teachers, customers, family. ____
Demonstrates a positive attitude. _____
Welcomes and accepts personal accountability for actions and behaviors. _____
Communication/Etiquette:
Smiles, listens, makes eye contact and treats everyone with dignity and respect. _____
Communicates requests, suggestions in a positive, non-threatening manner. _____
Service:
Willing and eager to assist at all times. _____
Personal:
Maintains the self-confidence and self-esteem of others. _____
Maintains a good relationship with others. _____
Takes the initiative to make things a little better. _____
Please answer the following questions:
- What are this student’s strengths as you see them to pursue a career in the health industry?
- In what areas do you think a career in the health industry will help this student grow and develop?
Print Name of Person Completing this Form: ______
Signature of Person Completing this Form: ______
Relationship to Applicant: ______
1