FAST TRACK PACKET
SJRMC AUXILIARY EDUCATIONAL ASSISTANCE FUND
PURPOSE
The primary purpose of the SJRMC Auxiliary Educational Fund is to financially assist qualified SJRMC employees and potential employees to enter into or upgrade their medical field specialization. The underlying goal is to retain recipients as long term employees at SJRMC after graduation.
IMPORTANT INFORMATION FOR APPLICANTS
The Auxiliary will notify all applicants whether or not they have been awarded educational funds.
The Auxiliary Educational Assistance Fund is capped at $750.00 per recipient, per semester. The amount disbursed will depend on actual expenses relating to the applicants course of study. Funds are to be used for books, tuition, testing fees and stethoscope fees only. These monies are specifically for the Spring 2014semester and any amount not used by the last day of the Fall semester will be returned to the Auxiliary Education fund. Applicants may request additional assistance for the next semester with a fast track process, with available funds up to $750.00, providing student is in good standing with an accumulative of at least a 3.0 cumulative GPA, as demonstrated by a grade report or unofficial transcript.
If one is awarded education funds, they must be repaid as outlined in the Educational Expense agreement unless the obligation of one year of employment is met following the completion of the program. See the agreement for detailed information.
Grade reports must be provided at the end of the semester. A copy of the certificate or diploma is required at the end of applicant’s program. If GPA falls below a 3.0 cumulative GPA, student can reapply after one semester through the Traditional Application process with proof of improved GPA.
Original receipts must also be provided for reimbursement once applicant is approved, or an invoice for payment to be made directly to the educational institution.
If the applicant fails a course, the Auxiliary will NOT pay for the course to be retaken.
Employee must be “in Good Standing” per Human Resources in order for the committee to consider the application.
Once approval is made, funds must be accessed by the end of approved semester, or forfeiture will occur. If unable to immediately access funds, a letter of explanation may be written to the Chairperson of the Educational Assistance Fund for consideration of extension.
INSTRUCTIONS FOR FAST TRACK APPLICANT (Already Received funds from Auxiliary last Semester):
1)Complete the attached Fast Track application.
2) Complete the attached certification of application to an accredited program ONLY IF YOU HAVE CHANGED YOUR COURSE OF STUDY, OR THE COLLEGE.
3) Provide copy of grades from the previous semester. Must be able to maintain a 3.0 cumulative GPA.
4) Provide a schedule of the classes to be taken for the Educational Assistance Semester. A tentative schedule is allowed, as long as an official schedule is provided before money is paid out.
Note: COMPLETED application packet is due toVolunteer Services or at the Information Desk no later than December 2nd, 2013.
Please initial each box that you understand requirements, and return with complete packet.
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Print NameDate
FAST TRACK FORM
FOR USE BY ANYONE REAPPLYING WITHIN ONE SEMESTER OF RECEIVING FUNDS FROM SJRMC AUXILIARY…AREAS IN RED ARE REQUIRED FIELDS AND MUST BE COMPLETED.
Name ______
Address ______
City______State ______Zip ______
Home Phone______Cell Phone______
Email address ______
SS#______Length of present employment______
Where areyou presently employed? ______
Present position______
Are you presently enrolled in college?______Field of Study: ______
Name of College and location______
______
Anticipated Graduation/Completion date for your program? ______
Is this the same college and program you were enrolled in last semester? ______
If no, please outline reasons for change:
______
______
LIST SPECIFIC COURSES YOU WILL BE ENROLLING IN FOR THE UPCOMING
SPRING 2014SEMESTER:______
______
Please list any other scholarship funds that have been awarded or that you have applied from the start of your program.
AGENCYAMOUNT
1) ______
2) ______
I CERTIFY THAT ALL OF THE ABOVE INFORMATION IS CORRECT TO THE BEST OF MY KNOWLEDGE AND THAT THE INFORMATION ON MY PREVIOUS APPLICATION IS STILL CURRENT.
Signature: ______Date: ______
Revised 05/2013
PLEASE COMPLETE THIS FORM ONLY IF YOU HAVE CHANGED YOUR COURSE OF STUDY, OR THE COLLEGE.
CERTIFICATION OF APPLICATION
TO AN ACCREDITED MEDICALLY-RELATED PROGRAM
THIS IS TO CERTIFY THAT ______
HAS MADE APPLICATION AT ______COLLEGE AND
HAS BEEN ACCEPTED TO ATTEND THE FOLLOWING PROGRAM:
______,
EFFECTIVE ______(DATE).
NAME/ADDRESS OF COLLEGE:
______
______
______
SIGNATURE OF COLLEGE REPRESENTATIVE:
______
PRINTED NAMEDATE
______
TITLE
______
CONTACT PHONE NUMBER