Little River Healthcare Recognizes Education As a Fundamental Catalyst in Realizing Human

Little River Healthcare recognizes education as a fundamental catalyst in realizing human potential. This scholarship program is established to enable interested Milam County students and Little River Healthcare employees to continue or pursue an education in healthcare. Five individual scholarships worth $5,000 each will be awarded this year to persons who wish to pursue careers in a medical-related field. No more than one of these five scholarships will be awarded to a Little River Healthcare employee.

BULLETIN OF INFORMATION

Through the scholarship program, Little River Healthcare seeks to help individuals realize their potential by providing financial aid to help achieve their educational goals.

Little River Healthcare scholarships may be used at any post-secondary school listed in the Education Publications, Inc. directory. This directory lists all post-secondary schools currently accredited by the U.S. Department of Education.

GENERAL INFORMATION

Any interested person may apply for these scholarships provided they meet at least one of the following criteria:

1) Be a current college student and resident of Milam County. This includes college students living outside of Milam County provided that their parents or guardians continue to reside in Milam County.

2) Be a full-time student at the senior level of high school attending class at a home or school located within Milam County.

3) Be currently employed at a Little River Healthcare hospital, practice, or office located within Milam County.

APPLICATION INSTRUCTIONS

Applications may be typed or hand-written legibly. Applications can be obtained from your high school counselor’s office or by going online to www.lrhealthcare.com/scholarship and downloading the application.

Deadline for this year is May 5, 2017. This is not the postmark deadline. All applications must be RECEIVED by this date. Applications may be mailed or delivered in person. You may deliver your application in person to the administration office behind the Little River Healthcare Rockdale Hospital. The mailing address is:

Little River Healthcare Rockdale Hospital

Scholarship Program

P. O. Box 1010

Rockdale, TX 76567

Delivery must be during the regular working hours of Monday through Friday, 8 a.m. to 5p.m. No electronic or faxed applications will be accepted.

SELECTION CRITERIA

A committee of senior professionals will evaluate all applications. Scholarship awards will be given based upon:

*Academic achievement and potential

* Leadership ability

* Character

* Volunteerism/community service

No provisions exist for reconsideration of applications after scholarships are announced. No applications will be returned.

AWARD INFORMATION

Recipients of scholarships will be announced by May 17, 2017. Award checks in the amount of $2,500.00 will be sent in August 2017 to the institution’s Office of Student Financial Aid. Award checks in the amount of $2,500.00 will be sent again in January 2018, provided the recipient is still in school and maintaining at least a 2.0 GPA. To receive the August installment, proof of enrollment must be received at the administrative office no later than Aug. 30, 2017. To receive the January installment, transcripts and proof of enrollment must be received at the administrative office no later than Jan. 15, 2018. Scholarship funds not used during any academic year will be returned to Little River Healthcare.

PREVIOUS RECIPIENTS

Previous Little River Healthcare scholarship recipients are eligible to resubmit an application to compete for the 2017 scholarship. Applicants must meet all application criteria.

THERE ARE TWO APPLICATION TYPES BELOW: ONE FOR CURRENT STUDENTS AT ANY LEVEL, AND ONE FOR LITTLE RIVER HEALTHCARE EMPLOYEES. ONLY COMPLETE AND SUBMIT THE APPLICATION THAT PERTAINS TO YOU.

2017 Application Form for High School & College Students

Incomplete applications will not be reviewed.

BEFORE COMPLETING THIS FORM, READ THE BULLETIN OF INFORMATION.

BE SURE TO FOLLOW THE APPLICATION INSTRUCTIONS CAREFULLY.

Applicant Information:

Name ______Social Security Number______

(Last) (First) (MI)

Home address ______

City______State ______ZIP ______Telephone ______

Date of Birth ___/ ___ /______Gender: ______Male ______Female

Name of Parent (s)______

Home address of this parent(s) ______

City/State ______

Name of your recommender______

Educational Information:

***FOR CURRENT HIGH SCHOOL SENIORS ONLY***

High School Name ______

Address ______

City ______

Honors courses attended? ______Yes ______No AP courses attended? ______Yes ______No

GPA ______on a ____ point scale. ACT Score ______SAT Score (Total) ______

Class rank ______out of ______

School you plan to attend the 2017 - 2018 academic year:

School Name City State

***FOR CURRENT COLLEGE STUDENTS ONLY***

High School Name ______

City ______

Honors courses attended? ______Yes ______No AP courses attended? ______Yes ______No

GPA ______on a ____point scale. ACT Score ______SAT Score (Total) ______

College Name ______

Address ______

City ______

Major______

Dates in attendance______

GPA ______on a _____ point scale

Academic Activities:

List all activities related to your high school and/or college in which you have participated, such as academics, publications, student government, drama, music, sports, clubs, etc. Do not abbreviate organization names.

Activity (MM/YY) To (MM/YY) Hrs/Wk Offices Held Special Awards or Honors

Community Activities:

List community activities in which you’ve participated without pay during your high school and/or college years, such as hospital volunteering, religious work, drug/teen/homework hotlines, outreach programs, etc.

Organization Type of Work (MM/YY) To (MM/YY) Hrs/WK

Employment:

List any regular or consistent employment you have held since beginning high school. This list should only include jobs that were paid and consistent. For example, occasionally babysitting for a family is not consistent, but nannying for a family on a regular schedule is considered consistent.

Employer Position (MM/YY) To (MM/YY) Hrs/WK

Essay: Explain what you would like the Scholarship Selection Committee to know about you and/or your family situation, including any unusual circumstances that may have affected your achievement. In addition, explain why you are choosing your desired profession. The essay portion is heavily weighted. This is your chance to tell the committee why you believe you deserve this scholarship. Do not exceed one page.

Applicant Certification

I certify that all statements contained in this application are true and correct, that I have read the Bulletin of Information, and that I believe myself to be eligible to apply for a scholarship under the provisions and conditions it contains.

Signature of Applicant ______Date ______

Parent Eligibility Certification

I certify that I am an eligible parent or guardian of the applicant, according to the guidelines stated in the Bulletin of Information.

Signature of Parent/Guardian ______Date ______

Review the following checklist. Make sure you have all the necessary signatures. Make sure you submit all the necessary documents. Submit all documents in one packet. Omitting any of these materials will disqualify your application.

Application Form - Original copy only. The original must be signed by:

· Applicant

· Eligible Parent

Essay - Original copy only. Typed or hand-written is acceptable.

Letter(s) of Recommendation - Original copy in a sealed envelope with recommender’s original signature.

No letters with a photocopied signature will be accepted.

Photocopies of official high school transcripts and official college coursework transcripts

Return completed application materials to:

Little River Healthcare

Scholarship Program

P. O. Box 1010

Rockdale, TX 76567

Applications must be RECEIVED by May 5, 2017.

Incomplete applications will not be reviewed.

2017 Application Form for Little River Healthcare Employees

Incomplete applications will not be reviewed.

BEFORE COMPLETING THIS FORM, READ THE SEPARATE BULLETIN OF INFORMATION.

BE SURE TO FOLLOW THE APPLICATION INSTRUCTIONS CAREFULLY.

Applicant Information:

Name ______Social Security Number______

(Last) (First) (MI)

Home address ______

City______State ______ZIP ______Telephone ______

Date of Birth ___/ ___ /______Gender: ______Male ______Female

Little River Healthcare location of employment ______

Name of your recommender______

Educational Information:

High School Name ______

City ______

GPA ______on a ____ point scale ACT Score ______SAT Score (Total) ______

Class rank ______out of ______

Trade School or College Name ______

City ______

Major______

Dates in attendance______

GPA ______on a _____point scale

School you plan to attend the 2017 - 2018 academic year:

School Name City State

Academic Activities:

List all activities related to your high school and/or college in which you participated, such as academics, publications, student government, drama, music, sports, clubs, etc. Do not abbreviate organization names.

Activity (MM/YY) To (MM/YY) Hrs/Wk Offices Held Special Awards or Honors

Community Activities:

List community activities in which you’ve participated without pay since entering the workforce, such as volunteering, religious work, drug/teen/homework hotlines, outreach programs, etc.

Organization Type of Work (MM/YY) To (MM/YY) Hrs/WK

Employment:

List any regular or consistent employment you have held since completing high school.

Employer Position (MM/YY) To (MM/YY) Hrs/WK

Essay: Explain what you would like the Scholarship Selection Committee to know about you and/or your family situation, including any unusual circumstances that may have affected your achievement. In addition, explain what you enjoy about your current position with Little River Healthcare, and why you are choosing to expand your education. The essay portion is heavily weighted. This is your chance to tell the committee why you believe you deserve this scholarship. Do not exceed one page.

Applicant Certification

Signature of Applicant ______Date ______

Application Form - Original copy only. The original must be signed by the applicant.

Essay - Original copy only. Typed or hand-written is acceptable.

Letter(s) of Recommendation - Original copy in a sealed envelope with recommender’s original signature.

No letters with a photocopied signature will be accepted.

Employee applications are not required to include high school or college transcripts.

Return completed application materials to:

Little River Healthcare

Scholarship Program

P. O. Box 1010

Rockdale, TX 76567

Applications must be RECEIVED by May 5, 2017.

Incomplete applications will not be reviewed.