HEART OF GOLD CHARITY INC.
SCHOLARSHIP FORM
Name __________________________________________________________________
Home Address __________________________________________________________
Phone Number __________________________________________________________
Date of Birth ____________________________________________________________
ACADEMIC ACHIEVEMENT
Class Rank
of
GPA ______on a scale of ________
High School Graduating From _______________________________________________
POST-SECONDARY PLANS
Major Program of Study ___________________________________________________
College/University or Tech School ___________________________________________
SPECIAL ACHIEVEMENTS
List extra-curricular and community activities (if necessary, please attach a separate sheet
of paper)
1. ______________________________________________________________________
2. ______________________________________________________________________
3. ______________________________________________________________________
4. ______________________________________________________________________
5. ______________________________________________________________________
ESSAY
Write a one page essay describing the reasons you have selected a career in the health
related field. (Please attach a separate sheet of paper)
Applicant’s signature ____________________________________ Date ___________
HEART OF GOLD CHARITY INC.
SCHOLARSHIP APPLICATION
Heart of Gold Charity Inc. is granting six scholarships in the amount of $1000 to the six
schools listed below. Students who are outstanding scholars and citizens, that will be
pursuing a career in the medical or nursing fields, are encouraged to apply. They will be
judged according to the following requirements:
1. The applicant must be a graduating senior from Badger High School (WI), Harvard
High School (IL), Johnsburg High School (IL), Munising High School (MI),
Richmond-Burton (IL) High School, or Wilmot High School (WI).
2. The applicant will provide a class rank and a grade point average.
3. The applicant will provide information in regards to post-secondary plans, or provide
a copy of the acceptance letter from a college, university, or technical college.
4. The applicant will provide a list of extra-curricular and community activities.
5. The applicant will provide an essay of one to two pages stating the reasons they have
selected a career in a health related field.
6. The applicant will provide two letters of recommendation from high school teachers
and/or Guidance Counselors.
7. Finally, the application must be turned into the Guidance Office by April 1, 2009.
Judging will be completed and voted upon by the board members of the Heart of
Gold Charity Inc. The monetary portion will be awarded after completion of the first
semester of college, whereby the scholarship winner will provide a transcript from their
college.
_____________________________________________________________________________________
Heart of Gold Charity, Inc. is recognized by the IRS as a 501 (c) (3) Non-Profit Charity
P.O. Box 116 Twin Lakes, WI 53181
(815) 790-1299
www.heartofgoldcharity.org
HEART OF GOLD CHARITY INC.
SCHOLARSHIP QUALIFICATION OUTLINE
Heart of Gold Charity Inc. is providing six scholarships (one per school) in the amount of
$1000 to students who are outstanding scholars and citizens that are interested in
pursuing a career in the medical or nursing fields.
Applicants will be awarded scholarships based on the following criteria:
-
A graduating high school senior from Badger (WI), Harvard, Johnsburg,
Richmond-Burton, (IL), Munising (MI), Wilmot (WI) High Schools.
-
Top 20% of their class, with at least a 3.0 GPA
-
Interest in pursuing a medical career or nursing degree
-
A good citizen, based upon community service.
-
Recommendation from education professionals
-
The recipients cannot be related to any of the board members of the Heart of Gold
Charity, Inc.
Judging will be completed and voted upon by the board members of the Heart of
Gold Charity Inc. The monetary portion will be awarded after completion of the first
semester of college, whereby the scholarship winner will provide a transcript from their
college.
______________________________________________________________________________________
Heart of Gold Charity, Inc. is recognized by the IRS as a 501 (c) (3) Non-Profit Charity
P.O. Box 116 Twin Lakes, WI 53181
(815) 790-1299
www.heartofgoldcharity.org