Dr. Ethel E. Johnson Memorial Scholarship
The Florida Society for Respiratory Care is proud to offer this scholarship in memory of a dedicated
Florida Board of Respiratory Care Board Member, and accomplished South Florida Educator. The
scholarship awards $500 and a free one year membership to the AARC/FSRC post graduation to a
Respiratory student who has demonstrated commitment to the highest standards in respiratory care
and to public health.
Scholarship Criteria: Non-Tobacco User
1.
Student must be entering or be in the last year of an accredited Respiratory program.
2.
Upon receipt of the application, the student must hold a minimum 3.0 out of 4.0, or
equivalent, GPA for all required Respiratory program course work.
3.
Student must demonstrate an aptitude for serving those afflicted with lung disease, as
well as a commitment to the Respiratory care profession.
4.
Student will have documentation of 8 hours of community service, preferably in
healthcare related organizations including but not limited to the FSRC, attendance at the
Florida Board of Respiratory Care meetings, American Lung Association, American Heart
Association, COPD Foundation, American Cancer Society, American Red Cross or other
medical-related organizations.
5.
Student must submit the completed application form, including all required
attachments, to the FSRC Executive Office as determined by the FSRC Board of Directors
(BOD).
.
AWARD NOTIFICATION
The selected recipient will be notified of their award by the date as determined by the BOD.
Notice of the award will be posted on the FSRC website and announced at a FSRC meeting to be
determined.
REVIEW/SELECTION PROCESS
Applications will be accepted if the postmark or electronic mail date meets the established due date,
and will be forwarded to the Qualification Committee for verification of criteria and completeness. The
committee will submit recommendations to the FSRC Board who at its sole discretion will select
recipients of the award.
The FSRC reserves the right to cancel, hold or refrain from making an award at any time for any
reason. The FSRC also reserves the right to provide Scholarship Awards to more than one qualified
candidate.
FUNDING
Scholarship funding will be provided through donations and special FSRC projects such as FSRC
cook book sales, golf tournaments, matching funds and other FSRC Board approved sources.
2011 Dr. Ethel E. Johnson Memorial
Scholarship Award Application
DEADLINE FOR RECEIPT OF APPLICATION: October 1, 2011
Mail completed application and required attachments to:
FSRC
P.O. Box 2500
Lutz, FL 33548
Attn: Dr. Johnson Scholarship Award Application
Or via Email to: fsrc@fsrc.org.
Please type or print the following information:
Name:
__________________________________________________________________________
(Last)
(First)
(MI)
Address:
__________________________________________________________________________
City: _______________________________________ State: ____________________
Zip:___________
Phone: ___________________________ Fax: ____________________________________
Email: ____________________________________Student ID # _____________________
School/Program:
_____________________________________________________________________
City: ________________________________________________ State: ____________
Date enrolled: ____________________ Expected completion date: ___________________
Degree obtained____________________________________
Program Director/Senior Faculty Member: _______________________________________
Phone:_____________________________Email:_______________________________________
Medical Director/Physician Instructor____________________________________________
Phone:______________________
Email:______________________________________
I understand that this application and the supporting documents and attachments are the
sole property of the Florida Society for Respiratory Care. Furthermore, I understand that
submission of this information is only an application and in no way guarantees award of the
Scholarship
Signature
of
Applicant:
Date:
Dr. Ethel E. Johnson Memorial Scholarship
ALL APPLICATIONS FOR SCHOLARSHIP AWARDS MUST BE ACCOMPANIED BY THE
FOLLOWING:
1.
A one to two page professionally written narrative outlining your academic,
professional and/or volunteer Respiratory experience and career goals including an
explanation of your reason(s) for choosing the Respiratory care profession.
2.
A Letter of recommendation from the Program Director, or clinical faculty member
attesting to the candidate’s(a) Progress in the Respiratory program, (b) Worthiness of the
scholarship award, and (c) Potential for a career in the Respiratory care profession. Please
include phone number, email and mailing address of each author.
3.
Completed signed application form; electronic signature accepted.
4.
Letter from Director of Admissions or Program Director verifying enrollment in an
accredited Respiratory program.
5.
Official transcript verifying a cumulative minimum GPA of 3.0 on a 4.0 scale, or
equivalent of respiratory classes. Electronic submission will be accepted to fsrc@fsrc.org.
This information may be submitted by letter to the FSRC under a separate cover or
electronically to the fsrc@fsrc.org. Attn: Dr. Johnson Scholarship Award Application