Healthcare Heroes College Scholarship Fund Grant Application

Healthcare Heroes College Scholarship Fund Grant Application

To promote education while assisting Healthcare Heroes' families
The Healthcare Heroes College Scholarship Fund offers a one-time $500 gift to a student of a current San Mateo Medical Center (SMMC) staff member. Multiple college or college-bound students within the same family can apply. Each calendar year, 20 scholarships of $500 each are awarded, totaling up to $10,000 annually from the Healthcare Heroes program fund.

An eligible student provides the following attachments to the grant form at time of request.
1. Copy of an official acceptance letter to student's college or trade school
2. Copy of current registration of classes
3. Brief 300+ word essay written by the student on how their SMMC family member has been a hero to them.
4. Proof of residence from the SMMC staff member AND student (if not included in the registration of classes)
Other eiligibility requirements:
- Birth children, foster youth, and children under guardianship must be living with the SMMC staff member (or prove that their permanent residency is the staff member's home while they are away at school).
- Must be among the first 20 eligible applicants within the calendar year.
- Submission of a fully completed grant form with all required supplemental documents at the time of request.
SMMC Staff Information
Name*

First NameLast Name
Work Email*
Must end with 'smcgov.org'
Department*
Student Information
Student Name*

First NameLast Name
Student Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Student Email*
Student Permanent Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Institution Information

Student's college or trade school
Name of Institution*
Institution Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Required Supplemental Documents
Acceptance Letter*

Upload a copy of your acceptance letter to your college, university, or trade school.
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Proof of Enrollment*

Upload a copy of your current class registration for the current application year.
Cancelof
Essay*

Upload a brief essay (300+ words) on how the healthcare hero you are living with has been a hero to you.
Cancelof
Proof of Residence (Staff)*

Upload a photo of a document showing your name and mailing address.
Cancelof
Proof of Residence (Student)

If not included in the proof of enrollment document, upload a photo of a document showing your name and mailing address.
Cancelof
Consent for Marketing Purposes

Must be signed by both the student and Healthcare Hero
I, student name*, consent to the use of my name, essay, and any related information for promotional or advertisement purposes by the Healthcare Heroes program or the San Mateo County Health Foundation.
Student (Applicant) Signature*

Clear
I, HH member*, consent to the use of my name and any related information for promotional or advertisement purposes by the Healthcare Heroes program or the San Mateo County Health Foundation.
Healthcare Hero Signature*

Clear
Date*

MonthDayYear
FOUNDATION USE ONLY
Approved By

First NameLast Name
Approval Date

MonthDayYear
Date
Reference/Project #
Fund
Notes
Amount
Check #
Check Pick-up

Picked up by (Name)Picked up on (Date)
Please verify that you have completed all the requirements before submitting your application. Allow 45 days for application processing from the initial submission date.
Should be Empty:

Healthcare Heroes College Scholarship Fund Grant Application

SMMC Staff Information

Student Information

Institution Information

Required Supplemental Documents

Consent for Marketing Purposes

FOUNDATION USE ONLY