Excela Health

Excela Health

Excela Health

Westmoreland Hospital Auxiliary

2014 Scholarship Application

The Westmoreland Hospital Auxiliary is offering scholarships to students committed to pursuing a career in a medical or health related field of study. The amount to be awarded to each recipient is $2000. Those who are eligible to apply must be graduating high school in 2014, or have graduated in the past five years from Greensburg Salem, Hempfield Area, Jeannette or Greensburg Central Catholic High School. Scholarship recipients are eligible to receive two scholarships during their educational career.

Application Instructions

The following items are required as part of the application. Any application that is returned incomplete will not be considered.

  1. A letter of admission or matriculation to an accredited program.
  2. A completed application form.
  3. A transcript of grades.
  4. A wallet-sized photo.
  5. Two letters of recommendation: one from a teacher from the past two years of school and one from a personal reference.
  6. Postmark application no later than April 25, 2014

Completed applications should be mailed to:

Mrs. Jennifer Marsh Kettering

424 Glenmeade Road

Greensburg, Pennsylvania 15601

Excela Health

Westmoreland Hospital Auxiliary

Application

Name______Birth Date______Age____

Address______

Phone______Alternate Phone______

College or University you will be attending______

Course of study or major you are pursuing ______

What are your career plans and goals as they relate to the medical field:

______

______

School(s) attended:

______Dates______

______Dates______

______Dates ______

Awards/Honors you have received:

______

______

Notable personal achievements:

______

School/Community Activities: (Please list in order of preference)

______

______

______

______

Statement of Financial Need

Financial need is the difference between the parents, and the students expected monetary contribution and the cost of the educational program the student is going to pursue.

Parent Information:

Parent(s)/Guardian(s) total annual income last calendar year $______

Parents/Guardians married ( ) single ( ) divorced ( ) separated ( ) widowed ( )

Dependent children:

1.______Age_____ School______

2.______Age_____ School______

3.______Age_____ School______

4.______Age_____ School______

Number of dependent children in post high school educational programs _____

Amount parent/parents able to contribute towards education $______

Student Information:

Savings $______

Estimate savings from possible summer employment $______

Amount student able to contribute towards education $______

Awards/scholarships received to date and amounts

______$______

______$______

______$______

Other loans or scholarships you have applied for:

______

______

School Information:

School of attendance______

Program of study______Length of program ______

Will you reside on campus____ rent____ commute ___

Tuition $______

Housing/Room & Board expenses for the year $______

Estimated expenses (books, travel, laundry, extras) $______

Verification:

We certify that the above information is true and accurate to the best of our knowledge.

______

Parent’s signature Date

______

Student’s signature Date