Auxiliary Scholarship

Scholarships

Crawford County Memorial Hospital Auxiliary Scholarship Application

This scholarship application is intended for first or second year college students who will, or are, pursuing a career in a healthcare field.

If you prefer to have a copy of the application emailed to you, please fill out the form to the right making sure you include your email address.

Submission Deadline: March 1

CCMH Auxiliary Scholarship

Auxiliary Scholarship Application

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Part I. General Information

Please provide your contact information.

Name(Required)

First Last

Date of Birth(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home/Cell Phone(Required)

Email(Required)

Pat II. Academic Information

Please provide the following information on your educational status.

Attach a transcript signed by a high school or college/university official.(Required)

Max. file size: 512 MB.

Part III. Activities/Leadership/Volunteer Work

List any organizations or extracurricular activities that involve you. Describe any leadership roles which you have experienced. What volunteer work have you done, besides that which may be a requirement of one of your school classes?

Please list activites/leadership/volunteer work below(Required)

Part IV. Financial Information

Since financial need is one factor in selecting the recipient of a CCMH Scholarship, the following information is critical to the selection committee for their deliberations. This information will be strictly confidential and is reviewed only by the members of the Scholarship Selection Committee.

Please upload the page of your FAFSA report which indicates your Expected Family Contribution (EFC).

Max. file size: 512 MB.

To which college have you been accepted and will you attend?(Required)

What are the annual costs for tuition?(Required)

What the annual costs for books and fees?(Required)

What are the annual costs for housing and meals?(Required)

How will your education be financed?(Required)

Have you received any other grants or scholarships which will aid in financing your education?(Required)

Do you have any unusual family circumstances that impact your need for financial aid?(Required)

Part V: Career Plans

Explain your professional career goals and objectives. Include specific details about what medical career you have chosen, why you have chosen it, and what you have done to prepare for such a career at this point in your life.(Required)

Please attach one letter of recommendation from a teacher, counselor, administrator, employer, pastor or other individual who is not a relative who can address your career plans and your character.(Required)

Max. file size: 512 MB.

Part VI: Financial Agreement and Signature

If I am awarded a scholarship by Crawford County Memorial Hospital, it is my intention to complete the health career program that I have described and to serve as a member of the profession for which I am preparing myself. I also agree to inform the Scholarship Committee of any decision to discontinue my education in any health career, and I agree to repay the scholarship funds within six months from the date of my withdrawal.

Signature of Applicant(Required)

Signature of Parent/Guradian (if the applicant is under 18)(Required)

Application Deadline: March 1 of each year

Please make sure you have attached your school transcript, one letter of recommendation, and the FAFSA summary page which shows the EFC. Once you submit the application, it will be forwarded to the CCMH Scholarship Committee for their review. Scholarship applicants will be notified of the status of their application no later than May 25.

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Crawford County Memorial Hospital Auxiliary Scholarship Application

CCMH Auxiliary Scholarship

Part I. General Information

Pat II. Academic Information

Part III. Activities/Leadership/Volunteer Work

Part IV. Financial Information

Part V: Career Plans

Part VI: Financial Agreement and Signature

Application Deadline: March 1 of each year

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