Health Careers Scholarship Program

Health Careers Scholarship Program

Scholarship purpose

The partnership between Grace Davis High School Health Careers Academy and HPSJ Health Careers Scholarship Program seeks to award a scholarship to two (2) high school seniors who plan to pursue a medical career as a physician at a four-year college or university, demonstrate an interest in community health, intend to practice in the Central Valley and demonstrate financial need.

Applicant Requirement: Must be a graduating senior of the Health Careers Academy pursuing a medical career. Must participate in the Health Careers Scholarship Program - Mentorship Program

HPSJ Award Amount: $2,500

Number of HPSJ Awards available: 2

APPLICATION TIMELINE:

· Completed application including all attachments must be received by March 21, 2016

· Applicants will be notified by the second week in April.

· Certificate Presentation: TBD by school

CHOOSE ONE (1) APPLICATION DELIVERY MODE:

· Mail via U.S. Postal Service to: Health Plan of San Joaquin, Attn: Angela Dennis, Health Careers Scholarship Program, 7751 S. Manthey Road, French Camp, CA 95231

· Apply online at HPSJ’s web site: www.hpsj/scholarship-program.com

· Download application at: www.hpsj/scholarship-program.com and mail via U.S. Postal Service

For more information, please contact: Angela Dennis at or 209-942-5252.

CHECKLIST:

1Scholarship and Mentorship Applications (completely filled out)

1Official, Recent Transcripts

1Completed Personal Statements

1Two Sealed Letters of Recommendation (mailed by recommenders via U.S. Postal Service)

1Personal Information Sheet

1Release Form

1Proof of Financial Need (i.e., Copy of W-2 Form)

APPLICATION FOR SCHOLARSHIP

GRACE M. DAVIS H.S. HEALTH CAREERS ACADEMY/Health Plan of San Joaquin

SCHOLARSHIP APPLICANT AND PARENT(S)/Guardian

This is a voluntary and confidential scholarship application form to be used by the scholarship committee. All applicants must be a graduating senior pursuing a career as a physician. In order to fully understand the applicant’s need and to make equitable choices of scholarship recipients, the information should be completed accurately.

(All responses must be typed).

Name: ______

Year Participated in Health Careers Academy: ______

Current Semester G.P.A.______

Cumulative G.P.A. ______

High School Attended ______Anticipated Graduation Year______

Your Planned Health Career: ______

Top three colleges to which you have applied:

Email Address______

Permanent Mailing Address (Home residence, P.O. Box, etc.)

______

City______State ____ Zip ______Telephone ______

Current Home Address (if different from permanent mailing address) ______

City______State ____ Zip ______Telephone ______

Date of Birth ______Place of Birth ______

Ethnicity/Race - Please check box that applies (optional)

1 Caucasian 1 Asian American 1 Pacific Islander

1 African American 1 Native American 1 Latino

1 Other______

Estimated Annual Family Income: $______

Names of the People in Your Household / Relationship to You

Number of Siblings Attending College in 2016______

Name: ______Years in school: _____

ACTIVITIES RESUME

Work Experience

Employer - Position / · Hours per week and the number of weeks worked
Start Date-End Date / · Describe your duties and responsibilities
Employer - Position / · Hours per week and the number of weeks worked
Start Date-End Date / · Describe what your duties and responsibilities

SPORTS

Describe Position Held / · Hours per week and the number of weeks this sport required
Start Date-End Date / · Describe any honors (varsity letter, team award, all-league, etc.)
Describe Position Held / · Hours per week and the number of weeks this sport required
Start Date-End Date / · Describe any honors (varsity letter, team award, all-league, etc.)

CLUBS

Club Name / · Hours per week and the number of weeks this club required
Start Date-End Date / · Describe any leadership roles that you held
· Describe what you did
Club Name / · Hours per week and the number of weeks this club required
Start Date-End Date / · Describe any leadership roles that you held
· Describe what you did
Club / · Hours per week and the number of weeks this club required
Start Date-End Date / · Describe any leadership roles that you held
· Describe what you did

Community Service Experience (specify volunteer and/or paid positions)

Organization / · Hours per week and the number of weeks this club required
Start Date-End Date / · Describe one important thing you did with/for this organization
· Describe any leadership roles that you held
Organization / · Hours per week and the number of weeks this club required
Start Date-End Date / · Describe one important thing you did with/for this organization
· Describe any leadership roles that you held
Organization / · Hours per week and the number of weeks this club required
Start Date-End Date / · Describe one important thing you did with/for this organization
· Describe any leadership roles that you held

Honors, awards and certificates

Award, Honor or Certificate / Organization / Year

PERSONAL STATEMENTS

Please answer each of the following questions using a maximum of 1 page for each question, typed.

1) Why do you want to be a medical professional and what have you done to explore this career?

2) Do you intend to practice in San Joaquin or Stanislaus, if so why?

3) What is a major healthcare concern in your community and how do you plan to impact change in your county?

Please answer the following question using a maximum three (3) pages, typed.

4) Develop a personal statement telling the scholarship committee about: 1) yourself, 2) your goals for the future, 3) obstacles you have overcome and how, 4) your health-related community service experience and 5) who or what experience has been the greatest influence in your decision to pursue a career in the medical field?

LETTERS OF RECOMMENDATION

Provide the letter of recommendation template to two (2) individuals who are familiar with your character, professional interest and involvement in the community. Please advise your recommenders to send or hand deliver the letter of recommendation to:

Health Plan of San Joaquin

Attn: Angela Dennis, Health Careers Scholarship Program

7751 S. Manthey Road

French Camp, CA 95231

I certify that all of the information in this application is valid and accurate.

I further certify that I have read the Mentorship Agreement and consent to participate in the Mentorship Program, if I accept the Health Careers Scholarship.

______

Student Signature Date

______

Parent/Guardian Signature Date