LAFAYETTE GENERAL FOUNDATION SCHOLARSHIP PROGRAM

SCHOLARSHIP APPLICATION

2018-19 Academic Year

Thank you for your interest in the Scholarship Program offered by the Lafayette General Health Foundation. The Lafayette General Foundation Scholarship Program is designed to encourage deserving applicants to continue their studies in higher education.

Applications for the 2018-2019 Award Year are due March 31st, 2018 by 5PM. Awards are made based on the availability of monies and number of applicants. The expected award/declination date is May 31st, 2018. Applications are reviewed after all supporting documents have been received. Please direct any questions about the Lafayette General Foundation ScholarshipProgram application process to Sheena Bouquet Ronsonet, Chair, Lafayette General Foundation Scholarship Program or Cian Robinson, Executive Director, Lafayette General Foundation. Please note that scholarship payments to selected recipients will be made directly to the School prior to the Fall Semester.

Eligibility:

  • Employee or dependent of a Full Time or Part Time Lafayette General Health employee who has been employed for a minimum of one year
  • Will attend or is attending a Louisiana college/university
  • Cumulative GPA of 2.5 or above

Please read all instructions before completing each form. Print clearly in ink or provide in a typewritten format. Use your correct legal name. If you name or address should change prior to notification of scholarship decision, please notify the Lafayette General Foundation office. Again, a complete application packet is necessary for application the Lafayette General Foundation Scholarship Program.The complete application packet you submit must contain the following:

  • Scholarship Application. Provide all requested information and sign the form. If you are an applicant under 18 years of age, then your parent/guardian must also sign the form.
  • Connect to Purpose Essay. 1500 words or less
  • Official Transcripts in sealed envelopes. An official, cumulative transcript is required from your most recent school attended.
  • Mail all materials to the following address:Lafayette General Health Foundation

Scholarship Fund

Attn: Human Resources

1214 Coolidge Ave

Lafayette, LA 70505

Applicants will be scored in a preliminary round utilizing the following criteria:

  • Academic – 20%
  • Community Involvement – 40%
  • Leadership (essay) – 40%

Top scoring applicants will be invited to the final round which will include an Interview.

LAFAYETTE GENERAL FOUNDATION SCHOLARSHIP PROGRAM

SCHOLARSHIP APPLICATION

2018-19 Academic Year

The following must be completed by the APPLICANT. Please type or print information.

Applicant’s Name Click here to enter text.

(Last Name)(First)(Middle Initial)

Employee Dependent

Lafayette General Parent or Guardian (if Applicant is Dependent):

Click here to enter text.

(Last Name)(First)(Middle Initial)(Emp ID #)

Address Click here to enter text.

City Click here to enter text. State Click here to enter text. Zip Code Click here to enter text.

Telephone Click here to enter text.

Email Click here to enter text.

High School Click here to enter text.Graduation Date Click here to enter text.

City Click here to enter text.State Click here to enter text.

GPA Click here to enter text.Class Rank Click here to enter text.

ACT Score Click here to enter text. &/orSAT Score Click here to enter text.

College/University planning to attend/attending

Click here to enter text.

City Click here to enter text.State Click here to enter text.

Start Date Click here to enter text.Full Time Student? (Y/N) Click here to enter text.

Degree Program or Vocation of Interest Click here to enter text.

Expected Date of Degree/Program Completion Click here to enter text.

Describe your work experience (if any) during the past four years. Indicate dates of employment. (Attach additional sheet(s) if necessary.)

Company / Position / Date From / Date To / Supervisor

List all school activities (if any) in which you have participated during the past 4 years. Include special awards, honors, and offices held. (Attach additional sheet(s) if necessary.)

Click here to enter text.

List all community activities (if any) in which you have participated during the past 4 years. Include special awards, honors, and offices held. (Attach additional sheet(s) if necessary.)

Click here to enter text.

List any special skills or interests that you have. Include any special awards or honors you received. (Attach additional sheet(s) if necessary.)

Click here to enter text.

The undersigned hereby acknowledges that the information provided in this application, including any enclosed documents, is true and correct to the best of their knowledge.

______

Applicant SignatureDate

LAFAYETTE GENERAL FOUNDATION SCHOLARSHIP PROGRAM

CONNECT TO PURPOSE ESSAY

2018-19 Academic Year

At Lafayette General Health (LGH), we believe in being servant leaders to our entire community – our patients, physicians, partners, and employees. To fulfill LGH's mission, To Restore, Maintain and Improve Health, the Foundation’s role is to find and connect the pieces, people and processes with our resources, our supporters and our heads and hearts. The Scholarship Fund specifically allows the Foundation to award scholarships to employees and their families who are seeking to better themselves through educational attainment. Through this, along with many other community programs, LGH demonstrates that, as a community-owned system, caring for all is our top priority.

ESSAY QUESTION (1500 words or less)

What does SERVANT leadership mean to you? Discuss 3 ways you demonstrated SERVANT leadership to others.