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Neodesha's Medical Scholarship Application



For your convenience, we will copy and submit your application for the following Scholarships.


The Hinrichs Family Scholarship

Jessie and William Post Scholarship

Ruth Stephens Memorial Scholarship Trust

Eunice Swartzleonard Scholarship

Rachel & Russell Vickers Nursing Scholarship


Medical Scholarships are for those students planning to return to the Neodesha area/Wilson Medical Center and include all medical fields:

Nursing, Medical Technology, Physical Therapy and others.



Name____________________________________________________________
Address____________________________________ SS#_________________

Phone [Day]_____________________ [Evening]______________________

High School attended____________________________________________
Year of graduation________________

Post secondary school attended__________________________________

Year of graduation______________________________________________

Name and location of school you will be attending

________________________________________________________________

Field of Study__________________________________________________

Have you applied for this program? ______ Been accepted? _______

Are you currently taking classes? ________ Start date? _________

Expected Graduation date _____________ Degree _________________

How many hours will you enroll in? Fall semester_______________

Spring semester_________________ Summer semester _____________

We understand this will not completely fund your schooling. How

do you plan to fund the rest of your education?

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________



Are there any extenuating financial considerations that should be

considered by the committee?

________________________________________________________________

________________________________________________________________

________________________________________________________________



On a separate sheet of paper, briefly answer the following:

1. Describe your future plans in the healthcare field, including how you intend to use your knowledge in the Wilson Medical Center Network.

2. List your previous work experience. Include employer

name and address, dates of employment and a brief description of your duties and responsibilities.



List any volunteer activities in which you have participated that improved healthcare_____________________________________________

________________________________________________________________
________________________________________________________________

What civic organizations are you a member of, or list civic contributions you have made to your community___________________

________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

Please provide supporting documentation:
High school and/or college transcripts.

Evidence you have applied to or have been accepted in an accredited healthcare program.

Provide names of 3 references-not family.

Include name, address, and phone number.



Please include a local name, address and telephone number (a family member or friend) who can serve as a long-term contact________

______________________________________________________________





Application deadline--June 5
Wilson Medical Center Foundation Office
P.O. Box 360
Neodesha, KS 66757