SCHOLARSHIP APPLICATION 2008

Shoshone Medical Center Foundation

C/O SMC Administration Office

25 Jacobs Gulch

Kellogg, ID 83837

208-786-0581

administration@shomed.org

Three scholarships are awarded each May by the SMC Foundation. They will be paid directly to the college at the beginning of the second semester upon receipt of proof of registration.

Submit applications to the SMC Foundation at the above address. They must be received by April 18 in order to be considered.

Eligibility: Any student who graduates or is a past graduate from a Shoshone County High School and plans to pursue a higher education in a health related field or any Shoshone County High School graduate who is currently enrolled in a school of higher education in a health related field.

 

PERSONAL INFORMATION:

Name:

Age:

Address:

 

 

Anticipated Field of Study:

Home address:

 

Father’s name & Address:

Occupation: Employer:

Mother’s name & Address:

Occupation: Employer:

List ages of brothers and sisters dependent on parents:

 

 

 

SCHOLASTIC INFORMATION:

High School currently Attending:

High School GPA:

 

Career Goals:

 

 

Why are you attracted to a career in health care?

 

 

 

 

 

 

 

 

Colleges applied to:

 

 

Colleges accepted by:

 

College currently attending (if applicable):

College GPA (if applicable)

ACTIVITIES

List school activities:

 

 

 

 

 

List community activities:

 

 

 

FINANCIAL INFORMATION

What is the combined annual income of both of your parents $________________

 

Please indicate any circumstances concerning your family’s financial situation which might be pertinent to this application:

 

 

 

 

 

If you are currently involved in a program, what financial assistance are you receiving:

 

 

 

REFERENCES

Please attach two letters of recommendation from either high school faculty members or faculty members of the institution you are currently attending.

 

 

SIGNATURE OF APPLICANT:

Date:

Applications are not considered if they are incomplete or if they are received after the due date of April 18.