Watertown Regional Medical Center

(1)$1,000 Health Careers Scholarship – 2016

Lake Mills High School

Prerequisites for Scholarship Program

PURPOSE:To stimulate interest in health careers within our service area high school students and enable candidates to pursue a health care career.

REQUIREMENTS:

  1. Applicants must reside and attend high school within theLake MillsSchool District.
  1. The applicant must be eligible for and have received notice of acceptance into an accredited healthcare program at a 4-year college or 2 year technical school. (Proof of enrollment is required, prior to payment of scholarship).
  1. Assistance will be granted to qualified applicants regardless of race, religion, color, sex, national origin or disability.
  1. Preference will be given to candidates ranking in the upper onethird of their graduating class. In the selection process, factors for consideration include the candidate's interests and participation in:
  • school and community activities
  • health-related job experience
  • reasons for choosing a healthcare career
  1. While not a requirement to apply, financial need will also be a consideration.

(1)$1,000 scholarship will be provided. Scholarships are administered by Watertown Regional Medical Center. Applications should be submitted to your high school guidance office. If you have any questions concerning the scholarship requirements please contact your school counselor or Audrey Wagie(920-262-4204) at Watertown Regional Medical Center.

Scholarship Year-2016

Watertown Regional Medical Center

Health Careers Scholarship

Please return the completed application to your guidance office.

This information will be reviewed by the Scholarship Committee at your school and will be treated with strictest confidence. Applications will not be accepted as complete unless all sections are completed.

1.Full Name______

2. Home Address______

______

3.Phone______Date of Birth______

4.Name and location of high school from which you will graduate? ______

______

5.Full name of Father ______

Where is above person employed______Occupation______

If deceased, when______

6.Full name of Mother______

Where employed______Occupation______

If deceased, when______

7.Number of other dependent children in the family______

Names______Ages ______

______

______

______

8.Do you, personally, have any financial dependents?______

If so, state number and relationship______

______

  1. Do you live with your parents?______If not, with whom? ______

______

10.School at which you have been accepted______

______

11.Program of study ______

FINANCES: A clear picture of your own and your family's financial position may be important.

12.Please list any financial considerations demonstrating that your financial need may become an obstacle in you ability to further your education. ______

______

______

______

13.Please list jobs you have held and number of hours worked per week during the past two years.

______

______

______

Have you been able to save any of this money toward your education?______

Amount $______.

14.If you have not worked during the past two years, how have you spent your nonschool time? ______

______

______

15.List student activities participated in during high school.

______

______

______

16.List community and/or other related activities participated in during last two years. ______

______

______

17.List any special recognition or awards received as a result of any of these activities. ______

______

______

18.Please enclose two letters of recommendation (e.g., principal, teacher or work reference).

19.Write at least one paragraph (on a separate page) telling why you are interested in a healthcare career.

20.Please enclose a complete transcript of your grades.

If you have any questions concerning this application, please contact your school counselor, or Audrey Wagie(920-262-4204) at Watertown Regional Medical Center.