Download Application - Maple Mountain High School

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Mountain View Hospital
Volunteer Auxiliary
Health Career Scholarship Application
To qualify for this scholarship, the applicant must be a graduating High School
senior who has been accepted into a college or university, and is pursuing a
career in health care.
Applicant must:
1. Complete the application form and include a short essay, (200 words or
less) describing his/her health career goal(s).
2. Attach a letter of recommendation from someone in the community, (not
a relative) such as an employer, civic group member, etc.
3. Attach a completed teacher evaluation form
4. Attach a transcript of grades
5. Attach a recent photograph
6. Applicant may also include ACT and/or SAT scores, but these are not
required.
Applicant will complete and return all of the above to the Director of
Volunteers at Mountain View Hospital, 1000 East 100 North, Payson,
Utah, on or before April 2, 2017. Late of incomplete applications will
not be considered.
Mountain View Hospital
Volunteer Auxiliary
Health Care Scholarship Application
_________________________________
High School
______________________________
Date
Applicant: __________________________________________________________
Address: ___________________________________________________________
City/State: __________________________________________________________
Date of Birth: ____________________
Social Security #: _____-_____-________
I have made application and been accepted to enter ________________________
(College/University)
I will begin classes on ______________ majoring in ________________________.
(Date)
(Career)
Write a short essay (200 words or less) explaining why you have chosen the
health care field and describing your health career goal(s).
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
________________________________________________________________
________________________________________________________________
(Please use an additional sheet of paper for more space)
_______________________________
(Applicant Signature)
MOUNTAIN VIEW HOSPITAL
HEALTHCAREER SCHOLARSHIP
EVALUATION OF SCHOLARSHIP APPLICANT
Name of Applicant: ___________________________
Address: ___________________________________
(Street Address)
Phone: __________________________
________________________________
(City/Zip)
High School: ________________________________________ _________________________
(Date)
PLEASE EVALUATE THE APPLICANT ON
THE FOLLOWING POINTS:
1. Desire for Health Career
2. Desire to help others
3. Initiative in planning service for others
4. Ability to plan and act constructively
5. Participating in school or civic activities
6. Ability to meet public and make friends
7. Acceptance of responsibility
8. Cooperation with leaders and teachers
9. Scholastic abilities and application
OUT
STANDING
ABOVE
AVERAGE
AVERAGE
BELOW
AVERAGE
Please list below any comments you might have concerning your personal contact and
participation with the applicant which might be helpful in this evaluation.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_______________________________________
Teacher Signature
(To maintain confidentiality, please seal the completed evaluation in a separate envelope
before returning it to the student applicant.)
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