SVEMG Medical Education Scholarship Application Form

Scholarship Application Form

Application Deadline - May 31, 2024
Birthdate

MonthDayYear
Thanks to generous donations from Salinas Valley Emergency Medical Group and other donors in our community, the Salinas Valley Health Foundation is proud to offer a scholarship for any current or former employee of Salinas Valley Health with at least one year of service, whose employment ended within the five years prior to application, pursuing a higher level of education in a health-related field. This fund is for individuals who have been accepted into Medical School or into other programs to become a registered nurse, respiratory therapist, or Physician Assistant. Priority will be given to those with financial need.

This scholarship is open to:

Any current or former employee of Salinas Valley Health with at least one year of service, whose employment ended within the five years prior to application.

Accepted into Medical School or into other programs to become a registered nurse, respiratory therapist, or Physician Assistant.
Amount Award and Terms:

$2,000 will be awarded annually (distributed to 1 or 2 students, depending on qualified applications received and selected).

Required Attachments to this Application:

1. Personal statement (essay) describing why you are interested in furthering your medical career and any other information about yourself that will be useful to the scholarship committee while considering your application.

2. Copy of the summary sheet of your most recently filed tax return (2022 or 2023)

3. Curriculum Vitae
Full Name*

First NameLast Name
Birthdate*

MonthDayYear
Cell Phone*
Email *
Home Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Gender*

MaleFemaleTransgender MaleTransgender FemaleNon-BinaryOther
Are you a US citizen or Permanent Resident Alien?*

YesNo
Qualifying criteria*

Current or former employee of Salinas Valley Health with at least one year of service, whose employment ended within the five years prior to applicationAccepted into Medical School or into other programs to become a registered nurse, respiratory therapist, or Physician Assistant
Program Start Date*

MonthDayYear
Date
Anticipated Completion Date*

MonthDayYear
Date
College(s) previously attended
Degree(s) completed, if applicable, and year(s) received
List any professional certifications that you currently have
Monthly Household Income (gross, from all sources, for all working adults in the household)*
Is financial aid necessary to continue your education?*

YesNo
Have you received, or do you expect to receive, a subsidy, grant, or other scholarship to assist with educational expenses?*

YesNo
Please attach your completed essay*

Cancelof
Please attach a copy of the summary sheet of your most recently filed tax return (2021 or 2022). Please redact any social security numbers*

Cancelof
Please attach your Curriculum Vitae.*

Cancelof
Frequently asked questions:

What are the tax implications for the scholarship recipient?
- The recipient must provide their social security number and will receive a 1099-MISC at the end of the year for tax purposes. The Salinas Valley Health Foundation will report the income to the Internal Revenue Service as required by law, and the recipient is responsible for all applicable taxes on that income.
- Scholarships received by students pursuing a degree at a “qualified educational organization” are NOT taxable income as long as they are used for tuition, fees, books, supplies, equipment required for courses (i.e. not living expenses).
- It is the student’s responsibility to declare taxable income, if any, on money received as a scholarship.
Who can i contact with questions?
- Please call the Salinas Valley Health Foundation office at 831.759.1823 or email smassolo@salinasvalleyhealth.com. Sheri Massolo will be able to assist you.
Applicant's Signature
By signing the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
Signature*

Clear
Should be Empty:

Scholarship Application Form

Applicant's Signature