McElmurray Scholarship Application Form

Dr. Charles McElmurray Scholarship Application Form

Phase One Application Deadline - April 1
The Dr. Charles McElmurray Scholarship Fund will provide grants for scholarships for South Carolina high school graduates interested in entering health professions at all levels (diplomas, certificates, Associate’s, Bachelor’s, Master’s, etc.). When possible, first preference will be given to graduates of Fairfield County schools, second preference for Chester and Lancaster County schools. High school graduation dates need not be recent, as we support working adults who want to change careers and enter health professions.

The application is a two-phase process. Phase One is to complete this form. Each applicant will be ranked according to academic performance (20 points), two faculty/employer evaluations (50 points), and an applicant essay (30 points).

All applicants scoring at least 70 or higher will move to Phase Two where documentation such as transcripts, school acceptance letter, and FAFSA will need to be verified. All applicants moving to Phase Two will be notified on or before the 30th of April.
I. Personal Data

Tell us about yourself
Full Name*

First NameLast Name
Birthdate*

MonthDayYear
Mobile No*
Email *
Where the confirmation will be send to
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please check your status at the time of application.

I will graduate high school this spring/summerI have already graduated high schoolI am a GED graduateI have attended college but have less than 32 college credit hoursI have attended college but have at least 32 or more college credit hours
High School Attended
Year of High School Graduation or GED
Are you a US citizen?

YesNo
Which school do you plan to attend?

Midlands Technical CollegeYork Technical CollegeUSC Lancaster campusUniversity of South Carolina (Columbia)Clemson UniversityMedical University of South CarolinaOther
Major Area of Study
Please indicate what your major area of study is/will be
Have you submitted an application for admission to your chosen school?

YesNo
Have you completed the Free Application for Federal Student Aid (FAFSA®) form? It can be accessed here https://studentaid.gov/h/apply-for-aid/fafsa.

YesNo
Are you interested to work in the healthcare industry in a rural area?

YesNoNot sure yet
In addition to a scholarship, would you like to be considered for internship opportunities with a company relevant to your major?

YesNoNot sure yet
Optional Information

Information regarding gender, ethnic origin and race are optional. The information is requested for post-scholarship report generation only and in no way affects your selection for college scholarship awards. However, providing this information may increase your opportunities for scholarships where donors have asked that priority consideration be given to students meeting certain demographic criteria (such as minority status, parent's place of employment, area of study, etc.)
Gender

MaleFemalePrefer not to answer
Please check your veteran status.

VeteranChild of a VeteranGrandchild of a VeteranSpouse of a VeteranNone of the AbovePrefer not to answer
Are you a first generation college student?

Yes, I am the first among my parents or grandparents to attend college.No, either my parents or grandparents have attended college.Prefer not to answer
II. Academic Performance (20 points)
School Name
Most recent cumulative GPA
Activities, community activities, volunteer work, honors, offices held
VII. Essay (30 points)
Your essay should be 500-1,000 words. You should address in your essay: your college goals and choice of major, what you intend to do with your education, and why a scholarship is important to you. Include any academic and non-academic accomplishments, personal characteristics, or experiences that make you uniquely worthy of scholarship consideration.
Essay

0/1000
VIII. Two Faculty/Employer Evaluations (25 points each)
Please secure two evaluations from either your academic faculty and/or employer. These references should include any academic and non-academic accomplishments, personal characteristics, or experiences that make you uniquely worthy of scholarship consideration. Evaluations should be one or two paragraphs and can be emailed to knichols@umrhn.org by the application deadline.
VI. Additional Information
Please check each of the qualifiers below that apply to you. Verification may be requested.
The Central Carolina Community Foundation, located in Columbia, SC, has an 11-county area including Fairfield County. The Foundation offers more than 200 Scholarships Award Opportunities with one single application, which is open between early January and early March. Applicants are expected to apply to this foundation. More information can be found here https://www.yourfoundation.org/grants-scholarships/scholarships/

YesNo
Have you applied for any applicable scholarships that are open to residents of South Carolina, such as the HOPE, LIFE, or other? More information can be found here https://che.sc.gov/students-families-and-military/scholarships-and-grants-sc-residents

YesNo
Fairfield County residents may be eligible for free tuition to Midlands Technical College. Visit this page https://www.midlandstech.edu/campuses/fairfield-campus or https://www.fairfieldsc.com/community/education/midlands-technical-college/the-fairfield-promise for more information. Are you exploring this option?

YesNoN/A
VIII. Applicant's E-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

Powered by Jotform SignClear
UMRHN, administrator of the Charles McElmurray Scholarship Fund, is committed to equal opportunity in employment and education. UMRHN does not discriminate in any program or activity on the basis of race, color, religion, gender, age, national origin, disability, marital status, or any other protected class.
Should be Empty:

Dr. Charles McElmurray Scholarship Application Form

I. Personal Data

II. Academic Performance (20 points)

VII. Essay (30 points)

VIII. Two Faculty/Employer Evaluations (25 points each)

VI. Additional Information

VIII. Applicant's E-Signature