School of Health Care Professions

School of Health Care Professions

2017-2018 Scholarship Application

DEADLINE: MARCH 5

Check scholarship(s) you are applying for:

☐ / Judith Ann Herrold Athletic Training Professional Scholarship / **Declared Athletic Training student
**After acceptance, must have completed, or be currently enrolled in, a minimum of 2-3 semesters in the UWSP Athletic Training major
☐ / Steven Blocher
Memorial Athletic Training Scholarship / **Athletic Training major, Junior or 1st semester Senior status
**3.0 GPA minimum
☐ / David and Julie Chitharanjan
CLS Scholarship / **Clinical Laboratory Science student accepted into professional program
**Placed at a clinical site
**GPA
**Professional activities
☐ / Harriet & Emil Pagel Memorial Scholarship / ** Clinical Laboratory Science major
**3.0 GPA or better
**Entering clinical in fall
☐ / Ida Stanke
Memorial Scholarship / **Clinical Laboratory Science major
**GPA
**Entering clinical in fall
☐ / Steven F. Schreiner
Health Care Professions Memorial Scholarship / **Clinical Laboratory Science majors have first priority
**HIMT or Health Science majors have second priority
**Have financial need
☐ / Tammy Feltz
Clinical Laboratory Science Memorial Scholarship / **Declared Clinical Laboratory Science Major entering clinical in the fall
**Academic performance
**Financial need
**Work experience
☐ / Robert G. Zach, M.D. Memorial Scholarship / **Committed Health Science student in 3rd or 4th year
**Maintained B average
**Financial need, & Wisconsin resident
☐ / St. Michael’s Hospital Clinical Scholarship / **Declared Health profession major
**Academic achievement
**Financial need
☐ / Mary Jo Tepp Boyne Memorial Nursing
Scholarship / **Declared Nursing major
**Have minimally completed the first year of the professional nursing program.
**Have financial need.
☐ / School of Health Care Professions
Faculty Scholarship / **Declared School of Health Care Professions major
**Entering final year of study on campus
**Academic Achievement
**Contribution to campus, community & School of Health Care Professions
☐ / School of Health Care Professions
Alumni Scholarship / **Declared School of Health Care Professions major
**Academic Achievement
**Aptitude for major
Name: / Major/Minor:
Intended Graduation Date: / Academic Advisor: / Student ID #:
Overall GPA: / Major GPA: / Overall with Transfer GPA:
Local Address: / Cell Phone #:
Year in College: / Total of Earned Credits:

Professional/Campus/Community or Volunteer Activities: List organizations (memberships, offices, held, special projects, and membership dates).

Organization / Offices Held / Special Projects / Membership Dates

Honors/Scholarships: List scholarships or honors you have received, date received, and a brief description.

Name of scholarship or honor / Date Received / Description

Work Experience: List positions held in paid employment and dates of employment.

Dates Employed / Employer / Job Title / Hrs/Wk

Financial Information:

Are you self-supporting? / Yes / No
Do you have a dependent child living with you?
Yes / No
For all scholarships:
Please indicate (in 100 words or less) why you are deserving of a scholarship. Include any personal and/or financial need information you are willing to share with the Scholarship Committee:

By electronically signing this application, I agree that my answers to the questions in this application are true, accurate and complete to the best of my knowledge.

Signature: / Date:

Return the completed application electronically toSusan Jankowski or drop off in the SHCP Office, D127 Science Bldg. by March 5, no later than 4:00 p.m.