Effingham Health System Auxiliary Scholarship Fund
Application must be submitted with all documentation by April 17th
The award amount is $500.
Turn in completed application to: Counselors Office
Remember to meet these qualifications and turn in all paperwork with your application.
o Have a 3.0 GPA
o Include a letter of acceptance from a college (or copy of your application) offering
a program of study leading to a medical career. Keep your original acceptance
letter and provide a copy only.)
o You can apply if you plan to go to a technical school, 2 year or 4 year school, are
at least a high school senior or in college.
o Write an autobiographical sketch including your plans for a health field career.
o Submit a photograph of any size.
o Must be a resident of Effingham County.
o Include three written letters of recommendation. Recommendations must be in a
sealed envelop and cannot be from personal friends.
o Show evidence of financial need in pursuance of a career in the medical field.
List income from all sources in your household.
o Include an official high school transcript or college transcript, if applicant is in
college. Transcripts must be in a sealed envelope.
Please note that scholarship funds for the recipient will be disbursed
to the chosen college or institution and not to the applicant.
Effingham Health System Auxiliary Scholarship Application
2013-2014
Personal Information:
Full Name
Social Security Number
Birth Date
Home Address
City
Zip
Marital Status
Spouse Name
Dependents (Name, Age, Relationship)
College You Plan to Attend (Name, Location
Education Information:
What is your professional goal?
What is your course of study? Present academic level?
What is your cumulative grade point average?
What school will you attend this next fall?
Will you attend school
Full Time
Part Time / Expected Graduation Date
If part time, specifically what else will you be doing?
Degrees or Diplomas Granted
What honors (academic or otherwise) have you received and when:
What sports have you participated in:
Occupational Information:
In what health or science related fields or activities have you been involved in for recreation, as
a volunteer, or as an employee?
List all jobs you have held and indicated whether they were full time or part time. Paid work
and volunteer work should be listed (employer, what kind of work did you do, dates).
Confidential Information: Income from all sources in household must be listed.
Father’s Name
Place of Employment (company, address)
Occupation and Approximate Income
Mothers’s Name
Place of Employment (company, address)
Occupation and Approximate Income
Number and Age of Siblings
How many in school?
How many in college?
Do you contribute to the support of any other person(s) or have other financial obligations?
Student Certification:
I declare that the information reported is true, correct and complete.
Signature__________________________________________Date________________
Scholarship Agreement:
It is agreed that:
1. The decision of the Scholarship Committee’s award is final.
2. Further personal and/or financial information will be provided to the committee if
requested.
3. Scholarship funding is to defray cost of tuition and is paid to the Georgia School of your
choice.
4. In the event the student does not start school or ceases course of study in related
health field, the scholarship funding will not apply and therefore the award will not be
paid.
I have read and clearly understand the above agreement.
This, the _________Day of ________________, 20____.
Student Signature_____________________________________________________________
Parent(s) or Guardian(s) Signature_______________________________________________
(912) 604-9616
E-Mail: Rosie9616@yahoo.com
Barbara K. Tumperi Scholarship
Georgia Hospital Association/Council of Auxiliaries/Volunteers
Application must be submitted with all documentation by April 17th
The award amount is $1000.
Turn in completed application to: Counselors Office
Remember to meet these qualifications and turn in all paperwork with your application.
o Have a 3.0 GPA
o Include a letter of acceptance from a college (or copy of your application) offering
a program of study leading to a medical career. Keep your original acceptance
letter and provide a copy only.)
o You can apply if you plan to go to a technical school, 2 year or 4 year school, are
at least a high school senior or in college.
o Write an autobiographical sketch including your plans for a health field career.
o Submit a photograph of any size.
o Must be a resident of Effingham County.
o Include three written letters of recommendation. Recommendations must be in a
sealed envelop. Letters from personal friends are not accepted.
o Show evidence of financial need in pursuance of a career in the medical field.
List income from all sources in your household.
o Include an official high school transcript or college transcript, if applicant is in
college. Transcripts must be in a sealed envelop.
Awards will be based on the applicant’s:





Scholastic records
Character
Qualities of leadership
Participation in student and community activities
Cooperation with school authorities
Please note that scholarship funds for the recipient will be disbursed to the chosen
college or institution and not to the applicant.
Barbara K. Tumperi Scholarship Application
Personal Information:
Full Name
Social Security Number
Birth Date
Home Address
City
Zip
Marital Status
Spouse Name
Dependents (Name, Age, Relationship)
College You Plan to Attend (Name, Location
Education Information:
What is your professional goal?
What is your course of study? Present academic level?
What is your cumulative grade point average?
What school will you attend this next fall?
Will you attend school
Full Time
Part Time / Expected Graduation Date
If part time, specifically what else will you be doing?
Degrees or Diplomas Granted
Honors (academic or otherwise) You Have Received (Name, Date)
Occupational Information:
In what health or science related fields or activities have you been involved in for recreation, as
a volunteer, or as an employee?
List all jobs you have held and indicated whether they were full time or part time. Paid work
and volunteer work should be listed (employer, what kind of work did you do, dates).
Confidential Information: Income from all sources in household must be listed.
Father’s Name
Place of Employment (company, address)
Occupation and Approximate Income
Mothers’s Name
Place of Employment (company, address)
Occupation and Approximate Income
Number and Age of Siblings
How many in school?
How many in college?
Do you contribute to the support of any other person(s) or have other financial obligations?
Student Certification:
I declare that the information reported is true, correct and complete.
Signature__________________________________________Date________________
Scholarship Agreement:
It is agreed that:
1. The decision of the Scholarship Committee’s award is final.
2. Further personal and/or financial information will be provided to the committee if
requested.
3. Scholarship funding is to defray cost of tuition and is paid to the Georgia School of your
choice.
4. In the event the student does not start school or ceases course of study in related
health field, the scholarship funding will not apply and therefore the award will not be
paid.
I have read and clearly understand the above agreement.
This, the _________Day of ________________, 20____.
Student Signature_______________________________________________________
Parent(s) or Guardian(s) Signature_________________________________________