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SUBMIT FORMSky Lakes Medical Center Scholarship Application Fillable PDF FormSky Lakes Medical Center Foundation offers scholarships to college students. The scholarships are madepossible by the generosity of Klamath-area families. This year there will only be ONE online applicationfor all FIVE scholarships. Your application will automatically be presorted based on specific scholarshipcriteria. Please review the following individual scholarship requirements to determine if any of thesescholarships are right for you.Eligibility varies by Scholarship Committee.Joann Burns Memorial Scholarship for Health and Science Education GPA minimum of 2.75, with preference to 3.0 and above.Accepted and enrolled full-time in any school for a health and/or science field.Lost a parent, sibling, aunt/uncle or grandparent to cancer.Attended a Klamath Basin High School, public or private.Volunteered 50 hours of community service and/or show proof of hours spent aiding anindividual battling cancer.James Bocchi Memorial Scholarship Non first-year college students attending and/or accepted into a nursing program at KCC orOHSU/OIT.Graduates from Klamath Basin High Schools, public or private.GPA at least 2.5 or equivalent.Klamath Falls Elks Nurse's and Health Careers Education Scholarship Priority to those attending/accepted into OHSU Nursing program.Studying health related fields.Priority to graduates from Klamath Basin High Schools, public/private.GPA of at least 2.0 or equivalent.Holman Scholarship OIT competitive student athletes only.Enrolled/accepted in any health occupations program at OIT.Dr. Ralph Waldo Stearns Scholarship Enrolled in any accredited school of nursing.GPA at least 2.0 or equivalent.High School diploma with course work in physics, chemistry, math or general science.Priority to graduates form Klamath Basin High Schools, public/private.Sky Lakes Medical Center Foundation Scholarship Application1
INSTRUCTIONS: It is encouraged that you pre-write all narrative entries in word and cut and pasteinto the fillable PDF form application. No letters of recommendations required. Once completeclick SUBMIT tab at the top of page one and email the following to Foundation@skylakes.org.A. Unofficial transcripts from High School and/or CollegeB. Resume with at least 3 referencesPERSONAL INFORMATION1. Date:2. Applicant Last Name:3. Applicant First Name:4. Applicant Date of Birth:5. If married, Spouse’s Name and Occupation:6. Email Address:7. Current School:8. School Address:9. School City:10. School State:11. School Zip code:12. Applicant Home Address:13. Home City:14. Home State:15. Home Zip code:16. Applicant Phone Number:COLLEGE FINANCIAL AIDE OFFICE – Where your scholarship award will be sent15. Name of college you plan to attend next year (2021-22):16. College Financial Aid office street address:17. College City:Sky Lakes Medical Center Foundation Scholarship Application2
18. College State:19. College Zip Code:20. Student ID:EDUCATION BACKGROUND21. Did you attend a High School in the Klamath Basin, either public or private? No22. List High Schools attended, the location, and dates attended:23. Current GPA:24. College Currently Attending:25. Year in College or College credit level equivalent: Freshman26. Name of School or College you plan to attend next year:27. If you are transferring from your present school or college, please state reason:28. List College’s attended, the location, and dates attended:29. From which school or college do you plan to graduate?30. Are you accepted and currently enrolled in an accredited nursing school program? No31. Are you currently enrolled in a health or science field of than nursing? No32. If answered yes, please name the field you are studying:Sky Lakes Medical Center Foundation Scholarship Application3
SPECIAL INTEREST AND WORK EXPERIENCE33. Have you volunteers over 50 hours of community service? No34. List activities (including volunteering) in which you have taken part during the last two years ofhigh school, in college or with the community/church organizations. Mention any specialrecognition received or offices held: (Example: school, activity, special recognition held)(limit 100 words)35. List special honors, prizes or scholarship you have received for academic work during your lasttwo year of high school and in college: (limit 100 words)36. Are you currently participating in OIT competitive sports? Yes37. Briefly describe your work experience (part time, full time, and volunteering). List employers, jobtitles, and description of work. Detailed explanation in attached resume. (limit 100 words)Sky Lakes Medical Center Foundation Scholarship Application4
FINANCIAL38. Are your parents helping you with college? Yes39. Have you been awarded scholarships for college? Yes40. List scholarships you have been awarded or have applied for:41. Are you getting any loans to pay for college? Yes42. Have you accrued any savings while not in college? Yes43. Are you earning money while attending school? Yes44. Do you have any other sources of income to help you with college expenses?45. What is the estimated total amount of additional cash needed for next year in college? (ex: 9,000)46. Other comments for the review committee regarding your financial need for college:YOUR REASONS FOR CHOOSING HEALTHCARE47. Have you ever lost someone to cancer? Yes48. If so, what relationship was that person to you? (limit 100 words)49. Were you involved in caring for the relative you lost to cancer? YesSky Lakes Medical Center Foundation Scholarship Application5
50. Why are you interested in becoming a nurse? Or why have you chosen your particular field ofhealthcare? (limit 100 words)51. EASSY QUESTION: Write about yourself, including hobbies, plans and aspirations, factors whichhave favorably or adversely influenced your life, health, reason for desiring to attend the schoolor college your have chosen, and any other information about yourself which you think ispertinent. (limit 450 words)Sky Lakes Medical Center Foundation Scholarship Application6
Attended a Klamath Basin High School, public or private. Volunteered 50 hours of community service and/or show proof of hours spent aiding an individual battling cancer. James Bocchi Memorial Scholarship Non first-year college students attending and/or accepted into a nursing program at KCC or OHSU/OIT.
