Heart of Gold Charity Inc

HEART OF GOLD CHARITY INC.

SCHOLARSHIP FORM

Name ______

Home Address ______

Phone Number ______

Date of Birth ______

ACADEMIC ACHIEVEMENT

Class Rank of GPA ______on a scale of ______

High School Graduating From ______

POST-SECONDARY PLANS

Major Program of Study ______

College/University or TechSchool______

SPECIAL ACHIEVEMENTS

List extra-curricular and community activities (if necessary, please attach a separate sheet of paper)

1. ______
2. ______

3. ______

4. ______

5. ______

ESSAY

Write a one page essay describing the reasons you have selected a career in the health related field. (Please attach a separate sheet of paper)

Applicant’s signature ______Date ______

HEART OF GOLD CHARITY INC.

SCHOLARSHIP APPLICATION

Heart of Gold Charity Inc. is grantingsix scholarships in the amount of $1000 to the six schools listed below. Students who are outstanding scholars and citizens, that will be pursuing a career in the medical or nursing fields, are encouraged to apply. They will be judged according to the following requirements:

1. The applicant must be a graduating senior from Badger High School (WI), HarvardHigh School (IL), JohnsburgHigh School (IL), MunisingHigh School (MI), Richmond-Burton (IL)HighSchool, or Wilmot High School (WI).

2. The applicant will provide a class rank and a grade point average.

3. The applicant will provide information in regards to post-secondary plans, or provide

a copy of the acceptance letter from a college, university, or technical college.

4. The applicant will provide a list of extra-curricular and community activities.

5. The applicant will provide an essay of one to two pages stating the reasons they have

selected a career in a health related field.

6. The applicant will provide two letters of recommendation from high school teachers

and/or Guidance Counselors.

7. Finally, the application must be turned into the Guidance Office by April 1, 2009.

Judging will be completed and voted upon by the board members of the Heart of Gold Charity Inc. The monetary portion will be awarded after completion of the first semester of college, whereby the scholarship winner will provide a transcript from their college.

______

Heart of Gold Charity, Inc. is recognized by the IRS as a 501 (c) (3) Non-Profit Charity

P.O. Box 116 Twin Lakes, WI 53181

(815)790-1299

HEART OF GOLD CHARITY INC.

SCHOLARSHIP QUALIFICATION OUTLINE

Heart of Gold Charity Inc. is providing six scholarships (one per school) in the amount of $1000 to students who are outstanding scholars and citizens that are interested in pursuing a career in the medical or nursing fields.

Applicants will be awarded scholarships based on the following criteria:

-A graduating high school senior from Badger (WI), Harvard, Johnsburg, Richmond-Burton, (IL), Munising (MI), Wilmot (WI) High Schools.

-Top 20% of their class, with at least a 3.0 GPA

-Interest in pursuing a medical career or nursing degree

-A good citizen, based upon community service.

-Recommendation from education professionals

-The recipients cannot be related to any of the board members of the Heart of Gold Charity, Inc.

______

Heart of Gold Charity, Inc. is recognized by the IRS as a 501 (c) (3) Non-Profit Charity

P.O. Box 116 Twin Lakes, WI 53181

(815)790-1299