St. Joseph's Hospital - Breese Volunteer Auxiliary Scholarship Application

Auxiliary Scholarship Application

This opportunity is for anyone entering a medical or allied health field in the coming Fall semester. A $1000 Grant in Aid will be awarded on June 30, 2022.

Completed applications are due by May 1, 2022.

Grant in Aid Application Guidelines

A biography (Personal Profile) will be on a separate sheet. All names of applicants will be covered during selection. The essay should be 1 or 2 pages and double spaced describing your background, what made you choose the particular program of study and also how you could benefit our community if chosen to receive the grant in aid.

The applicant must have a copy of the acceptance letter into the medical program from the college they will be attending in order to apply. Also, it is required that all paperwork be original each year, not photocopies of information from previous years.

All letters of recommendations are to be written within 3 months of application for scholarship.

Anyone entering the medical or allied health fields may apply. Please ask if you do not see a category from below:

Chiropractor	Nursing
Dental Assistant Training	Occupational Therapy
Dental Hygiene	Optometry
Dental Laboratory Technology	Pharmacy
Dentistry	Physical Therapy
Dietetics	Podiatry
Electrocardiograph Technology	Public Health
Hospital Administration	Radiology Technology
Licensed Practical Nursing	Respiratory Technology
Medical Laboratory Technician	Social Worker/Technologist
Medical Record Library Science Medicine	Speech Pathology & Audiology

There are no strings attached, however, since the money for the Grant in Aid fund comes from the Clinton County area, it would be nice if you could, upon graduation, work in this area or help to sponsor other candidates through your donation to the fund or help benefit our community through their work.

It will be called a Grant instead of a scholarship and will be given for the applicant to use to the best of their advantage.

$1000 will be given by the end of June. Applicants may re-apply every year, but their grades must be at least average.

Award can only be received one time.

Deadline: Applications will be made available in March each year. Applications are to be received by May 1, 2022. Applications may be applied for at a later date only in exceptional cases.

Only current residents of Clinton County are eligible to apply. Schools attended need not be an Illinois school. Grants will be made known by the end of May this year.

Award will be given in June, specific date will be determined at a later date. Your presence is preferred.

Any questions concerning the Grant in Aid applications may be directed to the Director of Volunteer Services at HSHS St. Joseph's Hospital Breese, Chris Gebke at 618-526-5351.

Apply Today! Fill out and submit the Grant in Aid application below.

First Name:
Last Name:
Father's Name:
Mother's Name:
Present Address:
Telephone Number:	( ) - Second three digits Last four digits
Birthdate:	Today
Permanent Address:
Dependents:	List the name, age and relationship of each dependent.
What is your occupational goal?:
What school will you be attending this fall?:
Enrollment Status:	Full Time Student Part Time Student
Expected Graduation Date:	Today
Residency Plans:	Dormitory Home Other
The course of study you are enrolled in:
Your academic level this fall:
If an undergraduate, what major have you declared:
Post-high school study:	Have you done post-high school study in a field other than that which you will be in this fall? If so, what; and how do you explain your change of interest?
Do you plan to stay in Illinois to work:	Yes No
Annual Family Adjusted Income :	Under $20,000 $20,000 to $60,000 $60,000 to $100,000 $100,000 to $150,000 $150,000 to $180,000 Over $200,000
Academic History:	List in chronological order all schools attended beyond elementary school. Include addresses and degrees or diplomas obtained.
Honors:	What honors, academic or otherwise have you received and when?
Health-Science Activities:	List health-science related fields or activities you have been involved in; either for recreation, as a volunteer, or as an employee.
Chosen Occupation Qualifications:	What particular qualifications do you feel you have for the occupation you have chosen? When did you decide on this field, and what were some of the factors which led to your decision?
Employment History:	List all jobs you have held (dates, employer, and type of work) and indicate whether they were full or part time.
Not in School:	If you are not currently in school, how have you been occupied since leaving school?
Primary Support:	Who is the primary contributor to your support?
Estimated Tuition & Fees Expenses:	Above and in the next fields, list your anticipated expenses for the coming school year.
Estimated Room Expenses:
Estimated Board Expenses:
Estimated Books & Supplies Expenses:
Estimated Personal & Other Expenses:
Estimated Transportation Expenses:
Estimated Total Expenses:
Personal Reference:	Attach a personal letter of reference that has been written within 3 months of this application.
Teacher Reference:	Please attach one letter of reference from a teacher or counselor that has been written within 3 months of this application.
Personal Written Profile:	Attach a briefly written profile of yourself, stressing aspects relevant to your occupational choice and goals. Should be 1 or 2 pages double spaced, describing his/her background, what made applicant choose the particular program of study and also how could he/she benefit our community if chosen to receive a grant in aid.
School Transcripts and Aptitude Test:	Attach your high school and/or college transcript and available aptitude and achievement tests. High school transcripts are not necessary if you have had more than one year of college.
Acceptance Letter:	Attach a copy of the acceptance letter into the medical program from the college you will be attending.
Security code:	Certify that the information in this form is to the best of my knowledge complete and valid.