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Kendall Smith Healthcare Exploration Scholarship Application

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2020 Kendall Smith Healthcare Exploration Scholarship
Advocate Lutheran General Hospital

Application – Department selections

Student's last and first name:

Please indicate the department of your interest below. You can make a maximum of two selections. Indicate your choices using numbers: 1st and 2nd choice. If you do not make any selections, your applications will be considered incomplete and rejected.

Adult Patient Care Nursing Units
This opportunity exposes students to an adult nursing unit; students perform various non-clinical tasks to help aid in the comfort and well-being of our patients. The tasks include responding to call lights, providing comfort items to patients, restocking supplies, assisting with an array of other non-clinical duties. Students may also be involved in special projects and unit meetings to gain a better understanding of the nursing profession and patient care. (Four positions available)
Adult Therapies
This outpatient facility provides comprehensive physical, occupational and speech therapy services to adult patients with a variety of neurologic and orthopedic diagnoses. Student in this department will have the opportunity to assist therapists in patient activities, provide light clerical assistance, as well as other miscellaneous non-clinical tasks. This facility is located off campus, at Church St. and Potter Rd. in Des Plaines. (One position available)
Expressions Program
This program is part of Older Adult Services. It is designed for people living with the earliest stages of memory loss. Components of the program include camaraderie, support physical activity, mental exercises, creative expression, and education regarding memory loss. Students in this program help with an array of non-clinical tasks including preparing and passing out activity supplies, assisting with discussion groups, and maintaining a clean and organized environment. Students may also be involved in special projects and unit meetings to gain a better understanding of early stage memory loss. Art Therapy and exercise are part of the daily activities. (One position available)
Genetic Counseling
This program is part of Advocate Medical Group Genetics Department. We see a variety of patients both adult and pediatric. Our physicians and genetic counselors meet with cancer and cancer risk patients, prenatal and preconception patients, along with pediatric patients with a span of medical indications. Genetic evaluations and testing can have medical, social and psychological implications for both patient, and their families. Students in this program will help with administrative tasks such as mailing and faxing consult letters, requesting medical records and other requested projects. They will also be able to discuss diagnosis and learn more about the field of genetics and genetic counseling, which is an interesting and growing field of medicine. (One position available)
Interventional Radiology Nursing
Refers to a range of techniques which rely on the use radiological image guidance (X-ray fluoroscopy, ultrasound, computed tomography [CT] or magnetic resonance imaging [MRI]) to precisely target therapy. Most IR treatments are minimally invasive alternatives to open and laparoscopic (keyhole) surgery. The student will perform various non-clinical tasks to help aid in the comfort and well-being of our patients. The tasks include responding to restocking supplies, assisting with an array of other non-clinical duties. Students may also be involved in special projects and unit meetings to gain a better understanding of the nursing profession and patient care. We welcome the opportunity to have you join our dedicated team! (One position available)
Surgical Services
This area covers two departments – Pre-Surgery and the Ambulatory Surgery Center where both pediatric and adult patients prepare for and undergo surgeries and procedures. Students in this department perform various non-clinical tasks to help aid in the comfort and well-being of our patients. The tasks will include providing comfort items to patients, restocking supplies, providing wheelchair assistance, and other non-clinical duties. Students may also be involved in special projects and unit meetings to gain a better understanding of the nursing profession and patient care. (One position available)
Radiology
This outpatient department is on the hospital campus at the Center for Advanced Care. It provides outpatient radiology testing that includes X-ray, Ultrasound, CAT scan (CT Scan) and MRI. Students in this area will provide numerous non-clinical duties such as walking patients to and from the reception area and their testing area, stocking basic supplies in the exam rooms, issuing discs with images to patients and a variety of clerical duties. Students may also be involved in special projects and department meetings to gain a better understanding of the radiology technologist profession. (One position available)

Application – Demographic information

Last Name: First Name:

Address City State Zip

Home Phone Cell Phone

Email Date of Birth

Do you have a Social Security or a tax ID number?

(You will be required to provide it upon acceptance to the program. The number is required to receive a stipend check.)

Parent/Guardian Name Parent/Guardian Phone

High School: Graduation Date:

Scholastic Average:

Are you able to be at the hospital six consecutive weeks starting the week of June 8th, 2020?

If no, please explain.

Are you able to be at the hospital during the week Mon-Fri between 8am – 5pm for either five 4-hour shifts or four 5-hour shifts? Longer shifts, evenings or weekends are not available.

School Activities and Honors:

Community/Volunteer Activities:

Work Experience:

Why are you interested in this opportunity and why do you think you will be a good fit for it?

Attach a separate letter answering this question. A maximum of one page, Times New Roman 12pt., single-spaced.

I fully understand that the program for which I am applying will be awarded by the Service League of Advocate Lutheran General Hospital whose decision is final.

Applicant Signature

Date

Parent or Guardian statement:

I, , the parent (guardian) of (applicant), have read this program application, confirm its contents, and consent to its filing with the Service League of Advocate Lutheran General Hospital. Further, I agree that the decision of the Service League Board of Directors will be final.

Parent or Guardian Signature

Date

Email the completed application (both pages) in a pdf file format to LGH-ServiceLeague@aah.org no later than end of day on Sunday, March 29th, 2020.

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What the Kendall Smith Healthcare Exploration Scholarship Application Is

The Kendall Smith Healthcare Exploration Scholarship Application is a standardized application form used to request financial support for students engaging in short-term healthcare education, observation, or professional development experiences. It gathers applicant identification, academic status, contact details, a personal statement, itemized budget estimates, references, and institution verification items used to confirm eligibility. Committees use the completed form to compare candidates, document award decisions, and retain a reproducible record for auditing and post-award administration. Supporting evidence commonly includes transcripts, proof of enrollment, and cost estimates.

Why a Structured Application Matters

A consistent application form ensures fair evaluation, captures required compliance data for education and healthcare-related funding, and creates an auditable record for award decisions, reporting, and administration while reducing review time and avoidable errors.

Why a Structured Application Matters

Who Completes and Reviews This Application

Typical users include students applying for funding, academic advisors verifying eligibility, scholarship administrators, and sponsoring organizations managing awards.

  • Undergraduate students exploring healthcare careers who need funding for clinical observations, conferences, or short courses.
  • Academic advisors and faculty recommending candidates and confirming enrollment or program relevance for scholarship reviewers.
  • Nonprofit foundations and employer-sponsored programs administering awards and tracking recipient outcomes for reporting.

Use this form when documenting award decisions, tracking disbursements, and maintaining program records for compliance and evaluation.

Core Sections Reviewers Expect

The Kendall Smith Healthcare Exploration Scholarship Application groups related inputs so reviewers can confirm eligibility, weigh educational impact, and verify budget realism. Each section should be complete and aligned with the stated exploration goals.

Applicant Information

Provides identity, contact, academic status, and institutional affiliation. Reviewers use this data to confirm enrollment, eligibility, residency status, and to prepare tax documents if awards constitute reportable income.

Personal Statement

A focused narrative explaining your healthcare exploration objectives, anticipated learning outcomes, and how the experience advances career plans. Tie goals to specific activities and explain measurable outcomes.

Budget

An itemized cost list with justification for each expense, showing amounts, vendor estimates, and total requested funds. Transparent budgets reduce reviewer questions and speed award processing.

References

Provide current contact information for academic or professional references who can attest to your qualifications and suitability for the healthcare exploration activity. Include relationship and timeframe.

Compliance Declarations

Sign attestations confirming enrollment, use of funds for stated purposes, and consent to record retention. Include any FERPA or HIPAA-related disclosures where PHI or educational records are involved.

Award Terms

Standard terms include disbursement timing, allowable expense categories, reporting obligations, and conditions for repayment or forfeiture. Clear acceptance reduces administrative disputes after funds are issued.

Step-by-Step Completion Checklist

Follow these steps to complete the Kendall Smith Healthcare Exploration Scholarship Application accurately and submit required attachments for review.

  • 01
    Start Application: Gather ID, transcripts, and enrollment verification before beginning.
  • 02
    Complete Fields: Fill every required field; use MM/DD/YYYY and two-letter state codes.
  • 03
    Attach Documents: Upload transcripts, budget, letters of recommendation, and invoices.
  • 04
    Review & Sign: Confirm accuracy, add electronic signature, and date the application.

Online Workflow Settings to Configure

Configure the online application workflow to collect attachments, route reviewers, and capture eSignatures with audit trails.

Form field and setting header How each field should be configured online
Authentication Method (signer verification via email or SMS code) Email link by default; SMS code optional
Required Attachments and file types accepted PDF, DOCX, or image files up to 10MB
Routing order and reviewer role assignments Route sequentially to advisor then committee
Signature capture settings and audit trail Enable audit trail with timestamps and IP

Submission-to-Award Flow at a Glance

Overview of the submission-to-award flow for the Kendall Smith Healthcare Exploration Scholarship Application, from applicant upload through committee decision and award disbursement.

  • Upload: Applicant uploads form and attachments online.
  • Verify: Administrator checks eligibility and supporting documents.
  • Review: Committee evaluates applications and ranks candidates.
  • Award: Committee issues award notice and processes disbursement.

Platform Features to Confirm Before eSubmission

The scholarship application supports online submission, eSignatures, and secure storage when hosted on compliant platforms.

  • File types: PDF and DOCX supported.
  • Integrations: Connects to Google Workspace, NetSuite, and Salesforce.
  • Authentication: Email, SMS, and optional KBA.

Security and Compliance Snapshot

Encryption: TLS 1.2/1.3 in transit; AES-256 at rest.
Access Controls: Role-based permissions and session timeouts.
BAA available: Business Associate Agreement for HIPAA-covered uses.
Audit Trail: Complete timestamped history of signer actions.
Authentication: Email OTP, SMS, and optional KBA.
Certifications: SOC 2 Type II, ISO 27001, PCI DSS.

Consequences of Incomplete or Incorrect Applications

Missing Documents: Application may be rejected.
Incorrect Amounts: Award adjustments or forfeiture.
Late Submission: May render applicant ineligible.
Privacy Breach: HIPAA violations possible; fines.
Tax Reporting: Scholarships may be taxable.
Backup Withholding: Incorrect TIN triggers 24% withholding.

Common Preparation Pitfalls to Avoid

  • Incomplete budgets lacking vendor estimates or totals often cause requests for clarification and delay awards by multiple review cycles.
  • Personal statements that are generic or unrelated to healthcare exploration objectives reduce reviewer confidence and lower competitiveness.
  • Uploading low-quality scans or wrong file formats prevents verification of transcripts and can force applicants to resubmit materials.
  • Failure to follow specified date formats or to initial required pages leads to processing errors and manual corrections by administrators.

Key Dates and Timing Expectations

Key submission and processing deadlines for the Kendall Smith Healthcare Exploration Scholarship Application, including recipient reporting and tax document timing.

Application Submission Deadline:

Set by program; typical academic cycle deadlines apply.

Notification of Award:

Committee communicates decisions within four to eight weeks post-deadline.

Disbursement Timing:

Funds issued after acceptance and any required paperwork completed.

Tax Reporting Period:

Reportable awards included in annual tax filings as required.

Record Retention Requirement:

Retain records per federal and state requirements.

How This Application Differs from Generic Scholarship Forms

Compare the Kendall Smith Healthcare Exploration Scholarship Application with generic scholarship forms to highlight differences in verification, privacy, and budget requirements.

Criteria Kendall Smith Generic Form
Notarization varies
HIPAA concerns possible unlikely
Academic verification required often optional
Budget detail detailed minimal

eSignature Vendor Pricing and Capability Snapshot

Pricing and core capabilities for common eSignature vendors. signNow appears first and is listed using verified plan data where available; competitor entries show typical price points.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day free trial Varies by vendor and plan Varies by vendor and plan Varies by vendor and plan Varies by vendor and plan
Bulk Send Yes (Business Premium bulk send) Yes Yes Yes No
Audit Trail Yes, full audit trail included Yes, full audit trail included Yes, full audit trail included Yes, full audit trail included Yes, full audit trail included
HIPAA Compliant Yes — BAA available upon request Yes — BAA available upon request Yes — BAA available upon request No No
Envelope Cap No envelope cap on paid plans Limited to 100 envelopes per user annually Varies by plan and vendor Varies by plan and volume Varies by plan and account

Frequently Asked Questions and Troubleshooting

Answers to common questions about completing, submitting, and e-signing the Kendall Smith Healthcare Exploration Scholarship Application.


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