Fill - Free fillable DRCHC SUSLA SCHOLARSHIP AGREEMENT FALL2019 SPRING2020 May19 (Southern University at Shreveport) PDF form

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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Awards may be rescinded should any information submitted for consideration be found to be Incorrect or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:

___________________________________________________________________________________________________________

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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