Fillable Information SINA Student Support Scholarship: SINAs REACH Committee (Capital Community College)

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Information SINA Student Support Scholarship: SINAs REACH Committee (Capital Community College)

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SINA Student Support Scholarship
Information
SINA Student Support Scholarship: SINA’s REACH Committee in collaboration with Capital
Community College (CCC) is offering a scholarship opportunity for students who reside in SINA’s
service areas who are continuing with their higher education. Up to four $500 scholarships in the
combined amount of $2,000 per year will be awarded annually to qualified CCC students.
Who is Eligible:
• Any full or part time credit seeking student that is a resident of Hartford neighborhoods
within the 06106 or 06114 zip codes.
• Student must have been enrolled a minimum of one semester and have a minimum
2.0 GPA at CCC prior to applying
• Applicants may be majoring in any field, but a preference may be given to majors in the
healthcare or education fields.
Application / Requirements:
• Fully complete the attached application.
• A personal statement (minimum of 350 words-maximum of 500 words) explaining why
they are seeking higher education and how the scholarship will assist in the completion of
a certificate or degree program. Applications without the personal statement will not be
considered.
• A recommendation form filled by a non-relative.
• Application must be submitted to Linda Torres at lvalentin@sinainc.org or mail
applications to the SINA office at 207 Washington Street, Hartford, CT 06106
• Deadline: Monday, April 19, 2021
Selection Process:
• SINA’s REACH Committee consisting of representatives from SINA’s institutions
(Hartford Hospital, Connecticut Children’s Medical Center, and Trinity College) will
review and select recipients.
• All applicants will be notified by mail at the address they list.
• If you are selected as a recipient, we would like to use a picture of you for use in print
and online publications. If you consent, please fill out and sign the image/essay release
section of the application.
Application Form
SINA Student Support Scholarship
TYPE OR PRINT (LEGIBLE)
Background Information
Name:
______________________________________________________________________________
PRIMARY MAILING ADDRESS: _____________________________________________________________
NUMBER STREET APARTMENT
______________________________________________
CITY STATE ZIP CODE
EMAIL: ______________________________________________________
TELEPHONE #: _________________________
Major: _____________________ GPA: _____________________
Expected to Graduate on: __________________
Please attach a personal statement (minimum of 350 words-maximum of 500 words),
explaining why you are seeking higher education and how the scholarship will assist in reaching
the goal of obtaining a certificate or degree.
Image/Essay Release
I ___________________________________, give permission to SINA to use my story/essay
(FULL NAME)
and image for print publications, the SINA website and events.
I give SINA, Inc., all right to images or negatives taken, and waive any right to compensation for
the publication or other use of these materials.
I consent to any noncommercial use of said photographs, motion pictures or video or any
duplication thereof for any purpose SINA may deem appropriate.
_____________________________________ ____________________
SIGNATURE DATE
OFFICE USE ONLY
CCC/SINA Scholarship Checklist:
____ Zip Code
____ Field/Major:___________________
____ GPA: ________________________
____ 1 Semester successfully completed
RECOMMENDATION FORM
For The SINA Student Support Scholarship Program
NAME OF APPLICANT:____________________________________________________
LAST NAME FIRST NAME MIDDLE INIT.
To the person completing this recommendation:
Please comment about the applicant’s character and/or career aspirations. Your candid opinion about the
applicant will be very important to us.
Helpful information can include: How do you see the scholarship helping the applicant? How do you think the
person can contribute to his/her field? How does this scholarship contribute to the applicant’s growth?
Thank you.
How long have you known the applicant and in what capacity?
_____________________________________________________________________________
Comments: (Attach additional pages, if necessary)
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Recommendation issued by: (Please Print)___________________________________________
Title/Position:__________________________________________________________________
Institution:_____________________________________________________________________
Signature:_____________________________________________________________________
If your applicant is selected, will you be willing to present them at the awards ceremony? Yes Maybe No
If so, please provide your contact information below:
Full Name: ____________________________________________________________________
Phone: (____) ______________ Email: _______________________________________
Mailing Address: _______________________________________________________________
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Information SINA Student Support Scholarship: SINAs REACH Committee (Capital Community College)

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Completed 3 February 2021

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