The Medical Center Auxiliary
MARY ANN PEASE
HEALTH CARE FIELD
SCHOLARSHIP
APPLICATION
THE MARY ANN PEASE SCHOLARSHIP
has been established
in honor of Mary Ann’s more than 20 years of commitment and devotion to The Medical
Center as the Director of Volunteer Services. Her intense efforts in establishing The Medical
Center Auxiliary has resulted in countless volunteer hours and devoted to improve health care
in our community. Mary Ann also developed the Youth Volunteer Program which has
encouraged countless young adults to choose health occupation careers. The Mary Ann
Pease Scholarship will be awarded to deserving young adults pursuing careers in the health
care field.
RETURN APPLICATIONS TO:
THE MEDICAL CENTER AUXILIARY
P. O. BOX 951
COLUMBUS, GEORGIA 31902-0951
ATTN: PEASE SCHOLARSHIP CHAIRMAN, BOX 89
E Mail address: nancy.williams@crhs.net
Applications are accepted year round.
Deadline for Fall Semester scholarships: April 30th .
Scholarships are presented in June.
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MARY ANN PEASE SCHOLARSHIP
CRITERIA
ELIGIBILITY:
1.
Scholarships will be available to eligible applicants pursuing Health Care
related degrees. SCHOLARSHIPS WILL NOT BE AVAILABLE FOR
NURSING OR PRE-NURSING PROGRAMS.
2.
Candidates for a Mary Ann Pease Scholarship must provide the following:
A.
B.
C.
D.
4.
Completed application.
Proof of acceptance into an accredited school.
Transcripts (originals) which show at least a B average in
previous academic work. Must be originals.
Three (3) signed letters of reference sent directly to the
Scholarship Committee to the address shown on cover page by
the individual who writes the reference. References may be
from high school teachers, college professors, and previous
employees—NOT personal friends, or relatives.
Candidate must participate in a personal interview with the Scholarship
Committee for each scholarship they are awarded.
CONDITIONS:
1.
$2000.00 scholarships will be awarded annually. Payments will be divided
evenly over the number of quarters/ semesters the student is enrolled.
2.
Each scholarship recipient will sign a promissory default agreement with The
Medical Center Auxiliary. Applicants under the age of 18 are required to
have a legal guardian as cosigner.
3.
Cancellation of the scholarship will occur if:
A. The student fails to maintain a passing grade in related academic
work.
B. The student fails to complete the program.
4.
Repayment of all scholarship monies will be due within 60 days after
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cancellation.
5.
Students must furnish to the Scholarship Committee a transcript of grades
following each semester/quarter of school; no additional disbursements will
be made until transcripts are received. (Must be originals)
6. The decision of the Scholarship committee is final.
Applicants under 18 years of age are required to have a parent or legal guardian cosign the application.
All correspondence (references, letters, transcripts, & applications) should be
mailed to:
The Medical Center Auxiliary
P.O. Box 951
Columbus, Georgia 31902-0951
Attentions: Mary Ann Pease Scholarship Committee
Email Address: nancy.williams@crhs.net
APPLICATION FORM BEGINS ON
PAGE 4
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APPLICATION
THE MARY ANN PEASE SCHOLARSHIP
1.
NAME
2.
SS # and Date of Birth
ADDRESS
4.
PHONE # (Include Cell & Home #)
3.
5.
CITY
STATE
ZIP CODE
6. EMAIL ADDRESS:________________________________________________________
7. List all schools you have attended starting with high school: (use extra sheets if necessary)
Applicants must provide original transcripts.
HIGH SCHOOL
Name and Address of School:
___________________________
___________________________
___________________________
___________________________
Date of Graduation:
Grade Average:
(GPA)
COLLEGE
Name and Address of School:
___________________________
___________________________
___________________________
___________________________
Date of
Attendance:
Date of
Graduation:
Degree Attained
Grade Average:
(GPA)
Name and Address of School:
___________________________
___________________________
___________________________
Degree Attained:
Date of
Graduation:
Degree Attained
Grade Average:
(GPA)
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8.
9.
List any other vocational, trade, or professional schools in which you have been enrolled:
Please list all employment you have held. (If this is not enough space, use extra sheets).
Employer Name & Address:
________________________
________________________
________________________
________________________
Dates of Employment:
From: __________________
To: ____________________
Supervisor:
________________________
Employer Name & Address:
________________________
________________________
________________________
________________________
Dates of Employment:
From: __________________
To: ____________________
Supervisor:
________________________
Description of Duties:
________________________
________________________
________________________
________________________
________________________
________________________
________________________
Description of Duties:
________________________
________________________
________________________
________________________
________________________
________________________
________________________
10.
Please list any professional, civic, church, social, or recreational organizations you
currently belong to:
11.
Please list any volunteer services/organizations you belong to & dates: (use extra sheets if
necessary.
Volunteer Organization:
Date(s):
Duties:
5
Volunteer Organization:
Date(s):
Duties:
Volunteer Organization:
Date(s):
Duties:
12.
Please list any awards, scholarships, special recognitions, or honors you have received
and the date(s). (Use extra sheets if necessary.)
13.
What college, school, or university do you expect to enter?
PROOF OF ACCEPTANCE MUST BE PROVIDED WITH THIS APPLICATION
When do you expect to graduate? __________________________
What degree will you have? ____________________________
14.
Please use separate sheet to respond:
A.
Discuss your short and long term goals for your health care career.
B.
Discuss how receiving this scholarship will assist you in achieving those
goals.
C.
Any other information you wish to provide
The above statements are true, to the best of my knowledge. I understand that
any scholarship awarded may be revoked if any statement is found to be false. I
understand that if I am awarded a scholarship it will be for a period of one
academic year, payable in equal installments for each semester or quarter
attended, and that I will be required to sign a contract. I understand that any
scholarship awarded and the amount awarded is subject to the availability of
funds.
____________________________________
Date
___________________________________
Signature of Applicant
Signature Parent/Legal Guardian
Dir: Peace/forms/pease scholarship application
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