University of Utah
College of Health
Dr. Lane and Paula Childs Scholarship
Application Deadline: February 15, 2016 by 4:30 pm
Today’s Date: _________________________________
Mr./Mrs./Ms. ______________________________________________________ Student I.D. # ________________
Home
Address ______________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Telephone Number ______________________________
Email_____________________________
Declared Major or Graduate Program (pre major not accepted) ________________________
Semester hours completed ________________________
Anticipated Graduation Date (semester & year) ________
Current GPA (listed on DARS) _______________
Other college(s) attended (if
any) _________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Resident of Utah?
Yes
No
If no, state or country of residence__________________________________
U.S. citizen or legally residing in the U.S.? Y / N
If no, please contact the Assistant Dean of Student Affairs in the College of Health prior to applying.
The following must be included in your application:
1. A statement no longer than two pages that includes a description of your academic and professional goals,
reasons why you feel you are a strong candidate for this scholarship, and any financial information that should
be considered.
2. A list of all scholarships and financial aid that you have received while attending the University of Utah.
3. A list of all other scholarships or sources of financial aid that you are applying for this year.
4. A list of any pertinent scholarly accomplishments, honors, or special awards of recognition you have received.
5. A description of your community involvement and/or university activities.
6. A current transcript of your grades (DARS is acceptable if printed as “List - List of Classes”). If you have been at
the University of Utah for less than two semesters, please submit a transcript from other schools attended.
Two letters of recommendation. Letters must be delivered separate from the application and must be signed and
sealed, and the sealed envelope must be signed across the flap with the author’s signature. All letters of
recommendation requests from students must have written permission from the student to release personal
information. A release form is available at:
http://registrar.utah.edu/_pdf/letter-of-rec.pdf
If you have questions about the application, please contact Shari Lindsey, Assistant Dean of Student Affairs,
at 801-585-5764 or visit HPER N 200 for more information.
Application Deadline: Friday, February 15, 2065 by 4:30 pm
Submit completed application and supporting documents to the Center for Student Success,
HPER North Room 200
Scholarship Opportunity
College of Health Dr. Lane and Paula Childs
Scholarship
Scholarship Process & Information
1. At least one annual scholarship shall be awarded to an outstanding College of Health student.
Recipients of these scholarships shall be known as Dr. Lane and Paula Childs Scholars.
2. Scholarship recipients shall be selected by the Dean of the College of Health and a faculty selection
committee
3. The scholarship award will be paid in one payment during fall semester.
4. A new scholarship recipient will be selected each year.
Scholarship Requirements
1. The scholarship recipient must maintain a minimum of 12 semester hours (9 for graduate students)
during the semester in which the scholarship is disbursed..
2. The scholarship recipient must have been enrolled a minimum of 12 semester hours (9 for graduate
students) for two of the three semesters in an academic year.
3. Applicants must have a 2.0 GPA at the time of application and award.
4. At the request of the donors, the scholarship will be awarded to an undergraduate or graduate student
who is married and is in financial need. Your University record must indicate that you are married.
If it is not current, please see Registration at Window 13, SSB. You must also fill out the FAFSA (Free
Application for Federal Student Aid) form at https://fafsa.ed.gov/.
5. Applicants must be a declared major within the College of Health (premajor does not qualify) or be
enrolled in a College of Health graduate program.
6. If the scholarship recipient changes majors within the College of Health, the scholarship will not be
affected. If the scholarship recipient changes majors to a discipline outside the College of Health, s/he
forfeits the remainder of the scholarship.
7. The scholarship recipient is expected to attend the fall semester Health Sciences Scholarship Luncheon.
8. Application will be disqualified if not submitted correctly, completely, and timely.
Scholarship Selection Criteria
1. Married and demonstrates financial need
2. Distinctive strengths (community service, leadership skill)
3. A well-written and compelling personal statement
4. Academic success and potential for success
5. A well-prepared application with excellent recommendations.
Scholarships, Fellowships, or Other Financial Aid
Any student who receives a scholarship, fellowship, or other financial aid administered by the University of Utah is
required by state law to certify that they are eligible to receive the scholarship as a U.S. citizen or a citizen of another
country who is lawfully present in the U.S. If students do not know whether they are in the U.S. lawfully, they should
seek the advice of an immigration attorney before filing a scholarship/financial aid application.
Student Citizenship Status (Check one of the following):
o
o
U.S. Citizen
Lawfully Present, Non-Citizen of the U.S.
Prior to the disbursement of any scholarship/financial aid, the University of Utah is required by law to verify with the
Department of Homeland Security (DHS) the lawful presence in the U.S. of students who are not U.S. citizens. Once
the University submits a student’s information to DHS for verification, this federal agency may have the legal right to
share the information with other government agencies.
Print Name Student ID ____________________________________________________________________
By signing this application, I certify under penalty of perjury that I am either a U.S. citizen or a citizen of another
country who is lawfully present in the U.S. I understand that my status and eligibility for financial aid/scholarship
within the U.S. will be verified through the Department of Homeland Security prior to an award of this
scholarship/financial aid.
Applicant Signature ________________________________________________________________________
Contact information for questions or concerns:
John Curl, Director of Financial Aid, jcurl@sa.utah.edu / 581-8788; or
Feleti Matagi, Director of Undergraduate Diversity Scholarships, f.matagi@utah.ed / 581-4378