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DAVID RAINES COMMUNITY HEALTH CENTERS
HEALTHCARE CAREERS SCHOLARSHIP
SCHOLARSHIP AGREEMENT
Fall 2019 Spring 2020
(5 candidates per academic year @ $1,000.00 each semester)
ELIGIBILITY:
To qualify, a recipient:
1. Must be accepted by Southern University at Shreveport (SUSLA) as a full-time student
2. Must have completed a minimum 12 hours attending at SUSLA
3. Must meet all other eligibility requirements of Southern University at Shreveport (SUSLA) to receive
financial assistance.
4. Must be a declared Nursing and/or Allied Health Major.
5. Must have a 3.0 Cumulative GPA.
6. Must submit the following information:
Official Financial Aid Transcript
Official Transcript or Letter from Registrar, (must include all grades through spring
semester)
Three (3) current Letters of Recommendations
Anticipated date of graduation
A COMPLETE APPLICATION CONTAINING ALL REQUIRED INFORMATION MUST BE SUBMITTED NO
LATER THAN MAY 19, 2019. LATE OR INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED.
OTHER PROVISIONS:
Awardee must maintain a 3.0 Cum GPA during the award period to continue to receive scholarship funds.
Awards would be distributed each semester provided the recipient continues to meet the award criteria.
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Scholarship funds are held and disbursed by the SUSLA Financial Aid Office and will not be given to a
recipient in the form of a check. The approved amount will be applied towards the recipient’s current semester
account balance (providing no discrepancies are realized at the time of submission) to the Office of Financial
Aid.
Awardee would receive only one (1) award during enrollment at SUSLA. Persons NOT selected to receive an
award may only reapply once during enrollment at SUSLA.
A scholarship committee will review applications and recommend candidates each academic year to the
chancellor.
Awards may be rescinded should any information submitted for consideration be found to be Incorrect or
untrue. Any funds disbursed shall be reimbursed and/or credited back to SUSLA.
Scholarship funds provided by David Raines Community Health Centers are not synonymous with university
scholarships and like guidelines do not apply.
All successful applicants must be available to accept their scholarship at David Raines Community
Health Centers Annual Scholarship and Health Careers Banquet meeting the 4
th
Thursday in August 22,
2019, at the Shreveport Convention Center, 400 Caddo, Shreveport, LA.
Please return your application to:
Dr. Alan Jackson
Assistant Director of Financial Aid
Southern University at Shreveport
Leonard C. Barnes Bldg. Room A-43
I have read and understand the above-stated eligibility requirements and rules. By completing and signing this
application, I agree to the conditions set forth by this agreement.
Signature: ______________________________________ Date: ______________________
Printed Name: ___________________________________ Semester: __________________
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DAVID RAINES COMMUNITY HEALTH CENTERS
HEALTHCARE CAREERS SCHOLARSHIP
APPLICATION
Fall 2019 Spring 2020
(Please print or type all information, all areas must be completed)
Applicant’s Name: _______________________________________________ S.S. #: __________-__________-_______
Address: ______________________________________________________ Apt#: ______________________________
City: ____________________________________State: _________________ Zip Code: _________________________
Phone (h): _______________________________(cell) ___________________Alt Contact_________________________
Major Field of Interest: _______________________________________________________________________________
Total # of hours pursuing this Semester: _____________________________Cumulative GPA: ___________________
Please give a brief description of your career goals:
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Please give a brief explanation of why you are applying for this scholarship:
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To certify that the information given on this application is true and correct to the best of your knowledge, please
sign below
__________________________________________ _____________________________________________
Applicant’s Signature Date
For Office Use Only:
Scholarship Awarded: ___________YES ___________NO
Award date: _____________________
DAVID RAINES COMMUNITY HEALTH CENTERS
Health Careers Scholarship for Allied Health and Nursing
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