Ginger Everson Memorial Scholarship - Gundersen Health System

2012-2013 School YearGinger Everson Memorial Scholarshipfor the Blair, Independence and Whitehall school districtsScholarship historyThe Ginger Everson Memorial Scholarship began in 1973 and honors Virginia “Ginger” Everson, aWhitehall High School student who died in a car accident that year. She had been accepted intothe nursing program at Viterbo College in La Crosse, Wis.Scholarship detailsThe Ginger Everson Scholarship will award $1,000 to a recipient enrolled in a four-year program.The funds will be distributed once, after the completion of the first year.Or: The scholarship will award $500 to a recipient attending a two-year program; those funds willbe distributed once, after the completion of the first year.In addition: At the scholarship committee’s discretion, it also may award additional smalleramounts to deserving applicants.Please note: The scholarship funds will be paid directly to the scholarship recipient, not to thepost-secondary institutionThe Ginger Everson Memorial Scholarship will be awarded to a deserving candidates pursuing ahealthcare-related courses of study. These can include: medicine registered nurse licensed practical nurse laboratory technologist radiology technologist pharmacy technician registered dietitian therapist or therapy assistant health information management healthcare social work healthcare administrationDeterminationThe scholarship committee will award the monies on the basis of the following: Scholastic ability Financial need Reference recommendationsScholarship committeeThe scholarship committee will be a team of Gundersen Tri-County patient-care representativeswho can best identify the qualities needed for success in the healthcare field.Gundersen Tri-County Hospital and Clinics Foundation18601 Lincoln St., Whitehall, WI 54773

Scholastic requirementsThe scholarship recipient will maintain at least a 3.0 (measured on a standard 4.0 grade scale) or Baverage to continue to be qualified to receive a Community Investment Healthcare Scholarship.At the conclusion of the first year of study, the recipient will report once by correspondence to thecommittee of their status and any planned changes. This correspondence should include an officialtranscript. Please note: All information submitted will remain absolutely confidential and will neverbe released in any manner.Scholarship application procedureApplicants must: complete the enclosed application; write a short letter (no more than onepage) describing their healthcaregoals and why they have chosen ahealthcare career; choose three character references -each of whom must write a shortletter in support. Those letters shouldbe included in this application.Community applicants should submit their applications directly to Gundersen Tri-County at theaddress below.High-school applicants should return the application and letter to their high school principal orguidance counselor. If necessary, they will verify information, provide additional support andcomments. The guidance counselors will forward all materials to Gundersen Tri-County Hospitaland Clinics.DeadlineAll applications and materials must be received by the Gundersen Tri-County Hospital andClinics Foundation by the end of the businessday on Friday, April 12, 2013.Mailing address Gundersen Tri-County Foundation, P.O. Box 65, Whitehall, WI 54773Attn: Pat Deninger, Public Relations and MarketingNotification - 2013The selection committee will notify the recipient and all applicants of the committee’s decisions bymail after the official notification. Please double-check to make sure your application includes youraddress, phone number and e-mail address.Additional notes A permanent file will be kept on each scholarship recipient and the money awarded. The scholarship may be terminated: (1) If the recipient drops or changes majors prior topayouts of any scholarship monies; (2) commits an act that would preclude the recipientfrom working in healthcare; (3) fails to meet any of the originally stated criteria. The committee may seek additional information as deemed appropriate from school andother officials in making their scholarship selection.2012-2013 School YearGundersen Tri-County Hospital and Clinics Foundation18601 Lincoln St., Whitehall, WI 54773

Ginger Everson Memorial Scholarshipfor the Blair, Independence and Whitehall school districtsApplicant’s Name: ________________________________________________ DOB: _______Address: __________________________ City ________________ State _____ Zip _______School district (adult applicants also should indicate which district they live in):___ Blair-Taylor___ Independence___ WhitehallParent(s) or Guardian(s): ______________________________________________________Address: __________________________ City ________________ State ____ Zip ________Parent/guardian occupations: ___________________________________________________When will you/when did you graduate from high school? _____________________________For high-school seniors: What is your graduating GPA? _________ Your class rank? ________Describe any special recognition you’ve received for excellence in school work (honors, prizes, etc.)____________________________________________________________________________________________________________________________________________________Describe any community work you’ve done (scouting, service work, community projects, etc.)____________________________________________________________________________________________________________________________________________________What post-secondary institution have you been accepted into? __________________________Estimated program length: _______________________________________________Estimated education expenses: ___________________________________________________Present sources and income to meet these expenses: ___________________________________Other possible sources: _________________________________________________________Has your family had emergency expenses or other unexpected factors that make it difficult orimpossible to contribute to your education? If yes, please explain: _________________________________________________________________________________________________Gundersen Tri-County Hospital and Clinics Foundation18601 Lincoln St., Whitehall, WI 54773

Employment historyStudent applicants: Work experience can be on home farm, family business or summer employment.Adult applicants: Work experience can highlight most-recent jobs; doesn’t have to be exhaustive.Workplace: ________________________________________________________________Employed from: ________________________ to: ________________________Address: __________________________ City ________________ State _____ Zip _______Work description: ___________________________________________________________Workplace: ________________________________________________________________Employed from: ________________________ to: ________________________Address: __________________________ City ________________ State _____ Zip _______Work description: ___________________________________________________________Workplace: ________________________________________________________________Employed from ________________________ to: ________________________Address: __________________________ City ________________ State _____ Zip _______Work description: ___________________________________________________________ReferencesList names three character references. Please don’t include relatives. Each must submit a shortletter of reference. Include these in your application.Name: _________________________________________________________________Relationship: ____________________________________________________________Address: __________________________ City ________________ State _____ Zip _______Name: _________________________________________________________________Relationship: ____________________________________________________________Address: __________________________ City ________________ State _____ Zip _______Name: _________________________________________________________________Relationship: ____________________________________________________________Address: __________________________ City ________________ State _____ Zip _______Applicant’s signature: ____________________________________________ Date _________Parent/guardian signature: ________________________________________ Date _________Thank you for your interest in Gundersen Tri-County’s Ginger Everson Memorial Scholarship!Gundersen Tri-County Hospital and Clinics Foundation18601 Lincoln St., Whitehall, WI 54773