Auxiliary & Foundation Scholarships Application

Greene County Medical Center Auxiliary & Foundation Scholarships

Application Deadline: April 1 each year
The Greene County Medical Center Auxiliary and Foundation Healthcare Scholarships provide financial assistance to students pursuing a nursing or healthcare-related degree. These scholarships offer up to $1,000 per year, up to four years, to persons who are entering or are already attending college in a healthcare field. Applicants must reapply each year. Scholarships are NOT limited to high school students.

Criteria:

Applicants must meet at least one of the following:
- A Greene County resident
- Live within the Greene County Medical Center service area
- Greene County Medical Center employee
- Family member of a Greene County Medical Center employee
- Applied for and/or received acceptance to an accredited school or college (prior to selection)
- Attending an accredited school or college (prior to selection)
Instructions & Procedures:
- Electronic applications are due each year April 1
- Required items include:
  
  Completed application
  
  Reference letter (minimum of 1)
  
  Transcripts from high school or college
  
  College Letter of Acceptance or other Proof of Enrollment
- Applications and required documents will be reviewed and recipients selected by a scholarship committee consisting of members from the Auxiliary and the Foundation
- Applicants will be notified of award or denial in May
- Scholarship checks will be paid directly to the college for the fall semester after being awarded
- At the time of application, if you do not have a Student ID#, please email it to executive.assistant@gcmchealth.com by July 15, email titled Scholarship ID. If not received, scholarship will be forfeited
Questions:

Please email executive.assistant@gcmchealth.com or call 515-386-0102 with questions.
FOR MEDICAL CENTER USE ONLY

Application Received Date: ___________________TranscriptsCollege Letter of Acceptance or Proof of EnrollmentReference Letters (minimum of 1)

Greene County Medical Center Auxiliary & Foundation Scholarship Application
Applicant Information
I am a (select all that apply)*

Graduating HS SeniorReturning College StudentGreene County Medical Center EmployeeFamily Member Greene County Medical Center Employee
Name*

First NameMiddle InitialLast Name
Address*

Street Address

Apartment/Unit #

CityState

Zip Code
Date of Birth*

MonthDayYear
Date
Cell Phone Number*

Area CodePhone Number
Personal Email*
(Do not use school email)

Parent/Legal Guardian Information

Information below relates to applicant's parent(s) or legal guardian(s)
Name 1

First NameLast Name
Address 1

Street Address

Street Address Line 2

CityState

Zip Code
Name 2

First NameLast Name
Address 2

Street Address

Street Address Line 2

CityState

Zip Code

College
Name of College*
Student ID#
If not available at time of application, please email to executive.assistant@gcmchealth.com by July 15, title of email Scholarship ID#. If not received, scholarship will be forfeited.
Financial Aid Office Address*

Street Address

Street Address Line 2

CityState

Zip Code
I am Obtaining a Degree In*

Graduating High School Students

Must fill out all information below to be considered for scholarships
High School Name
GPA
Guidance Counselor Name

First NameLast Name
Graduation Date

MonthDayYear
Date
Guidance Counselor Email
example@example.com
Activities
Volunteer Work
Awards/Honors

Returning College Students

Must fill out all information below to be considered for scholarships
Select:

2nd Year3rd Year4th YearMasters & Beyond
Anticipated Graduation Date
GPA
Activities
Volunteer Work
Awards/Honors

Employment
Are you currently employed?*

YesNo
*If yes, complete section below
Employer
Years Employed
Hours/Week
Essay Questions

200 words or less
What motivated you to choose a degree in healthcare?*
What impact do you hope to make in healthcare in your future?*

Applicant's Certification and Agreement
I certify that the foregoing information is true and correct. I authorize the Auxiliary and/or Foundation at Greene County Medical Center to make inquiries concerning me, any of the persons mentioned in this application and of the high school/college I attend or will be attending. The Auxiliary and Foundation Healthcare Scholarship will be awarded without regard to race, sex, religion or age. Greene County Medical Center reserves the right not to process applications found to be incomplete as of the application deadline.
Signature*

Clear
Date*

MonthDayYear
Date
Attachments
File Upload

Cancelof
Letter of Reference (minimum of 1)Transcripts from High School or College (If a non-traditional student--adult returning to college--with no transcripts, Proof of Enrollment can be substituted)College Acceptance Letter or Proof of Enrollment
Should be Empty:

Greene County Medical Center Auxiliary & Foundation Scholarships

Greene County Medical Center Auxiliary & Foundation Scholarship Application

Applicant Information

Parent/Legal Guardian Information

College

Graduating High School Students

Returning College Students

Employment

Essay Questions

Applicant's Certification and Agreement

Attachments