PORTAGE COUNTY HEALTH AND
HUMAN SERVICES EMPLOYEES FOUNDATION
AMY TRZEBIATOWSKI, PRESIDENT
(715) 345-5239 FAX (715) 345-5966
RUTH GILFRY CENTER
817 WHITING AVENUE
STEVENS POINT, WI 54481-5246
Application for Jane Shaurette, Public Health Nurse, Scholarship - $500
PERSONAL DATA
Social Security No.
Name: Last
First
Permanent Home Address (Street, City, State, Zip)
Middle
Telephone No.
Have you been accepted by or currently attending a University, College, or Technical
School:
Yes
No
High School Attended:
Graduation Year:
University, College, or Technical School Attending:
Graduation Year:
Cumulative G.P.A. on a 4.0 Scale:
Expected Family Contribution (EFC) from FAFSA:
Degree/Major:
Nursing
Dietetics
Health Education
Environmental Health
LIST OF VOLUNTEER ACTIVITIES/COMMUNITY SERVICE:
Short Essay: Describe your current and future goals.
Describe Your Financial Need:
PORTAGE COUNTY HEALTH AND HUMAN SERVICES EMPLOYEES’ FOUNDATION
Jane Shaurette Memorial Scholarship
Special Requirements:
The following selection criteria shall be utilized when reviewing applications and
selecting recipients:
Must not be a previous recipient of this scholarship.
Must be a permanent Portage County resident.
Must be pursuing a post-secondary degree in Nursing, Dietetics, Health
Education, or Environmental Health.
Demonstrate academic success by having a minimum 2.75 GPA.
Must include two letters of reference.
Financial need will be considered:
Include a summary explaining your “Financial Need”
You will need to apply for the Free Application for Federal Student Aid
(FAFSA). It can be obtained by visiting www.fafsa.gov for more information.
Once completed, you will receive both an Expected Family Contribution (EFC)
code and also a Student Aid Report (SAR). Please keep both for your records.
Include a copy of your EFC/FAFSA report. Applicants who do not provide a copy
of this report will not be considered.
How did you find out about this scholarship opportunity?
School
Portage County Website
Other (specify):