WHEATON FRANCISCAN HEALTHCARE - ALL SAINTS FOUNDATION
Application for Wheaton Franciscan Medical Group –
Family Medicine & Walk-In Care Scholarship
Deadline Friday, January 1, 2016
The Wheaton Franciscan Medical Group –Family Medicine & Walk-In Care Scholarship is offered to current
associates and/or their children seeking to further their education in pursuit of a degree and/or certificate at
any accredited 2-4 year university or college. This scholarship was generously supported by WFH – All Saints
Foundation and the Wheaton Franciscan Medical Group – Family Medicine and Walk –In Care Departments
are pleased to afford our associates this opportunity for financial support in accordance with our value of
Development.
Scholarship Criteria:
1. The applicant or applicant’s parent must be a WFH – All Saints Associate working a minimum of 20
hours per week within either the Family Medicine and Walk-In Departments here at All Saints and must
be in good standing.
2. In applicable, applicant must be a graduating high school senior in good academic standing and/or
enrolled in an accredited college, university, or technical business trade school.
3. The applicant must have plans to pursue additional education at a college, university, or accredited
technical business trade school. The applicant does not need to pursue a degree in healthcare.
4. The applicant must complete the form and write an essay on one of the questions listed below.
 What do you feel is the biggest challenge facing today’s youth? Why?
 Who has been your mentor or role model? Why does this person play that role for you?
 What is one of your proudest accomplishments in life to date?
5. Two letters of reference from individuals other than family members must be submitted. One letter
should be from a teacher or counselor from high school or employer based reference.
6. All applications must be in typed format, hand-written applications will not be considered.
*Any exception to these criteria may be reviewed and considered by the Scholarship Committee.
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Scholarship Process:
Scholarship applications available via TauNet, or call WFH- All Saints Foundation at 262.687.8654.
Please include two letters of recommendation with this application or have them mailed directly to the
address below. One letter should be from a Supervisor, Manager or Director within WFH - All Saints or
High School Teacher, and the other a general character reference (not from a relative).
Scholarship applicants are required to provide college/high school transcripts showing academic
performance in recent coursework.
The scholarship recipient may be asked to meet with the respective scholarship donor and will be asked
to attend a scholarship awards reception, tentatively scheduled for March 2017.
Return completed applications to: WFH - All Saints Foundation, Attn: Scholarship Committee,
3805B Spring Street, Suite 220, Racine, WI 53405, faxed to 262-687-8655 or dropped off at the Human
Resources office.
I have familiarized myself with the eligibility requirements established for the Wheaton Franciscan Healthcare – All
Saints Foundation Scholarships. I agree not to hold liable the scholarship committee as a whole, or it members, to any
obligations, financial or otherwise, if it becomes necessary at any time to discontinue said scholarship. Scholarship
checks will be mailed directly to the school. I understand that any monies awarded and not used for the purposes of
this scholarship will be returned to Wheaton Franciscan Healthcare – All Saints Foundation. I authorize Wheaton
Franciscan Healthcare – All Saints Foundation to release my information concerning my application and likeness for
purposes of publicity if I am awarded the scholarship
Signature:
Date:
Signature of parent or guardian if applicant is under age 18:
Date Submitted:
Personal Information:
Name:
Mailing Address:
Telephone: work
home
Start Date at WFH - All Saints:
Manager at WFH – All Saints:
cell
Present Occupation: :
Educational Background:
1. College or professional school (if more than one attended, attach information)
 Name and location:
 Years attended:
 Date graduated:
 Degree:
 Major:
 Cumulative GPA on 4.0 scale:
2. Additional education:
3. List any extracurricular school activities and any educational honors received:
School Information & Expenses:
1. What school are you attending for your nursing education?
2. Are you attending full-time or part-time? How many credits
per semester?
3. What degree are you working toward?
4. When do you hope to complete your studies?
5. List below the annual expenses at the school you will attend:
 Tuition and fees for next year
 Room and board for next year
 Books and supplies
 Miscellaneous and personal expenses
 Total expenses for next year
6. Describe any special circumstances concerning your need for
financial aid:
$
$
$
$
$
7. Please list any other scholarships or financial awards you
anticipate receiving:
Wheaton Franciscan Medical Group –
Family Medicine & Walk-In Care Scholarship
Employment/Community Service:
1. List present and former employers related to your career goals:
Dates:
Name and Address:
Position:
2. List any community service activities you have been involved in:
Organization:
Activity:
For Scholarship Committee Use Only:
o Signature
o Transcript included
o Two Letters of Reference included
o Typed Application and Essay
Wheaton Franciscan Medical Group –
Family Medicine & Walk-In Care Scholarship