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Health Care Scholarship Application

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HEALTH CARE SCHOLARSHIP APPLICATION

CASCADE EAST AREA HEALTH EDUCATION CENTER | ST. CHARLES FOUNDATION

Cascade East Area Health Education Center (CEAHEC) and the St. Charles Foundation currently offer student scholarships for students who are interested in pursuing a health care career and practice in rural Oregon as a certified nurse assistant (CNA), registered nurse (RN), nurse practitioner (NP), physician assistant (PA) or any other health care profession.

COMPLETED APPLICATION AND SUPPORTING DOCUMENTATION MUST BE RECEIVED BY MARCH 19, 2020, BEFORE 5 P.M.

APPLICATION REQUIREMENTS

CENTRAL OREGON RESIDENCE. All applicants must have resided or enrolled in school(s) for a minimum of four years in one of the following central Oregon counties:

DESCHUTES, CROOK, JEFFERSON, LAKE, GRANT, HARNEY, KLAMATH, OR WARM SPRINGS INDIAN RESERVATIONS

FINANCIAL NEED. The following chart is used to determine low-income status based on house-hold size.

Household Size* 2 3 4 5 6 7 8 For each addition person, add:
100% ** $17,240 $21,720 $26,200 $30,680 $35,160 $39,640 $44,120 $4,480

* Include only dependents listed on Federal income tax forms

**Adjusted gross income for the last calendar year

INTEREST IN HEALTH CARE CAREER WITH DESIRE TO PRACTICE IN RURAL OREGON. Applicant must have a desire to pursue a career in a health care field and explain interest in practicing in rural Oregon.

SPECIFIC SCHOLARSHIPS

PLEASE READ THROUGH EACH SCHOLARSHIP’S SPECIFIC REQUIREMENTS. CHECK ALL SCHOLARSHIPS FOR WHICH YOU QUALIFY AND WOULD LIKE TO BE CONSIDERED FOR:

CERTIFIED NURSE ASSISTANT SCHOLARSHIP

CEAHEC BOARD SCHOLARSHIP FOR HIGH SCHOOL & COLLEGE STUDENT

CEAHEC SCHOLARSHIP FOR RURAL OR FINANCIALLY DISADVANTAGED STUDENTS

CEAHEC SCHOLARSHIP FOR MINORITY/BILINGUAL STUDENTS

CEAHEC NURSING SCHOLARSHIP FOR HIGH SCHOOL SENIORS

CEAHEC NURSE SCHOLARSHIP EXTENSION FOR A SECOND OR THIRD YEAR NURSING STUDENT

CEAHEC NURSE SCHOLARSHIP FOR ENROLLEES IN A NURSE PRACTITIONER OR PHYSICIAN ASSISTANT TRAINING PROGRAM

MARY ANN THOMAS-HOSIER NURSE SCHOLARSHIP FOR HIGH SCHOOL SENIORS

MARY ANN THOMAS-HOSIER NURSE SCHOLARSHIP FOR ADN/BSN SCHOLARSHIP

GENERAL INFORMATION

NAME (FIRST, MIDDLE, LAST):

DATE OF BIRTH (MM/DD/YYYY):    AGE:

ADDRESS:

CITY: STATE: ZIP CODE:

PHONE: E-MAIL:

GENDER IDENTIFICATION (CIRCLE ONE): MALE    FEMALE

ELIGIBILITY

CENTRAL OREGON RESIDENCY

CENTRAL OREGON RESIDENCY CAN BE FULFILLED BY ONE OF THE FOLLOWING, PLEASE CHECK ONE & PROVIDE SUPPORTING INFORMATION

COUNTY OF RESIDENCE: LENGTH OF RESIDENCY (YEARS):

COUNTY OF SCHOOL ENROLLED: LENGTH OF ENROLLMENT (YEARS):

HEALTH CARE INTEREST

WHAT IS YOUR CURRENT CAREER ASPIRATION?

PROGRAM CLAIM STATUS (PLEASE CHECK ALL THAT APPLY)

FINANCIAL DISADVANTAGE

HAVE YOU OR YOUR FAMILY MEMBER EVER BEEN QUALIFIED FOR FREE AND REDUCED LUNCH AT YOUR SCHOOL? YES NO

FAMILY SIZE: ADJUSTED GROSS INCOME:

FIRST GENERATION COLLEGE STUDENT

PARENT #1 HIGHEST LEVEL OF EDUCATION (CIRCLE ONE): ELEMENTARY (K-8) HIGH SCHOOL/GED COLLEGE

PARENT #2 HIGHEST LEVEL OF EDUCATION (CIRCLE ONE): ELEMENTARY (K-8) HIGH SCHOOL/GED COLLEGE

MINORITY

ETHNICITY (PLEASE CHECK ALL THAT APPLY):

AMERICAN INDIAN/ ALASKAN NATIVE

ASIAN

BLACK/AFRICAN AMERICAN

HISPANIC/ LATINO

NATIVE HAWAIIAN/ OTHER PACIFIC ISLANDER

WHITE/ CAUCASIAN

OTHER (PLEASE SPECIFY):

ARE YOU BILINGUAL? YES NO   IF YES, PLEASE SPECIFY OTHER LANGUAGES:

RURAL

PROFESSIONAL EXPERIENCE OR VOLUNTEER HISTORY

JOB TITLE: DATE (MM/YYYY): FROM TO

EMPLOYER/ORGANIZATION:

ADDRESS:

CITY: STATE: ZIP CODE:

PHONE: E-MAIL:

BRIEF DESCRIPTION OF JOB DUTIES:

JOB TITLE: DATE (MM/YYYY): FROM TO

EMPLOYER/ORGANIZATION:

ADDRESS:

CITY: STATE: ZIP CODE:

PHONE: E-MAIL:

BRIEF DESCRIPTION OF JOB DUTIES:

JOB TITLE: DATE (MM/YYYY): FROM TO

EMPLOYER/ORGANIZATION:

ADDRESS:

CITY: STATE: ZIP CODE:

PHONE: E-MAIL:

BRIEF DESCRIPTION OF JOB DUTIES:

EDUCATIONAL BACKGROUND

CURRENT EDUCATION:

HIGH SCHOOL    PLEASE CIRCLE ONE: FRESHMAN SOPHOMORE JUNIOR SENIOR

COLLEGE    PLEASE CIRCLE ONE: FRESHMAN SOPHOMORE JUNIOR SENIOR

GRADUATE PROGRAM

OTHER (PLEASE SPECIFY):

NOT CURRENTLY IN SCHOOL (PLEASE SPECIFY):

HIGH SCHOOL EDUCATION

SCHOOL NAME:

ADDRESS:

DATE OF ATTENDANCE (MM/YYYY): FROM TO (EXPECTED):

SPECIALIZATION (IF ANY): GPA:

COLLEGE EDUCATION

(IF YOU ARE NOT IN COLLEGE, PLEASE PROVIDE INFORMATION ON THE COLLEGE INSTITUTION YOU PLAN ON ATTENDING THIS FALL)

SCHOOL NAME:

ADDRESS:

DATE OF ATTENDANCE (MM/YYYY): FROM TO (EXPECTED):

MAJORS/MINORS: GPA:

OTHER RELEVANT EDUCATION

PROGRAM TYPE (TECHNICAL SCHOOL, GRADUATE SCHOOL, POST-BACH EDUCATION, ETC.):

SCHOOL NAME:

ADDRESS:

DATE OF ATTENDANCE (MM/YYYY): FROM TO (EXPECTED):

MAJORS/MINORS (IF APPLICABLE): GPA:

PLEASE ATTACH MOST CURRENT SCHOOL TRANSCRIPT WITH YOUR APPLICATION

FINANCIAL STATEMENT

MARITAL STATUS (PLEASE CIRCLE ONE): SINGLE MARRIED DIVORCED SEPARATED

TOTAL NUMBER OF DEPENDENTS (DO NOT INCLUDE SELF):

DURING THE UPCOMING ACADEMIC YEAR, I WILL BE LIVING (PLEASE CIRCLE ONE):

WITH MY PARENTS    WITH RELATIVES    ON MY OWN

OTHERS (PLEASE SPECIFY LIVING SITUATION):

PLEASE PROVIDE THE FOLLOWING BUDGETING NEEDS FOR THE UPCOMING ACADEMIC YEAR (SEP 2020 – JUN 2021)

TUITION & FEES $

BOOKS & SUPPLIES $

COLLEGE ROOM & BOARD (THIS DOES NOT INCLUDE MORTGAGE OR FAMILY FOOD BILL) $

OTHERS EXPENSES (PLEASE SPECIFY: I.E., CHILD CARE, TRANSPORTATION, OUTSTANDING DEBTS, MORTGAGE PAYMENT FOR NUMBER OF MONTHS IN SCHOOL, OTHER COSTS FOR CERTIFICATION)

$

$

$

$

ESTIMATED TOTAL EXPENSES $

PLEASE PROVIDE THE FOLLOWING INFORMATION REGARDING EXPECTED INCOME:

SAVINGS $

EXPECTED INCOME DURING SCHOOL YEAR (SEP 2020 – JUN 2021) $

EXPECTED SPOUSE’S INCOME DURING SCHOOL YEAR (SEP 2020 – JUN 2021) $

OTHER INCOMES (PLEASE SPECIFY: I.E., AWARDED SCHOLARSHIPS & GRANTS, RELATIVES, TRUSTS, LOANS, ANNUITIES, CHILD SUPPORT, AND ALIMONY)

$

$

$

$

ESTIMATED TOTAL EXPENSES $

BY SIGNING BELOW, I VERIFY THAT THE FINANCIAL INFORMATION LISTED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE.

SIGNATURE OF SCHOLARSHIP APPLICANT

DATE

CASCADE EAST AREA HEALTH EDUCATION CENTER (CEAHEC) PARTICIPATION

PLEASE CHECK ANY OF THE FOLLOWING CEAHEC STUDENT PROGRAMS IN WHICH YOU HAVE PARTICIPATED IN:

YOUR PARTICIPATION IN A CEAHEC STUDENT PROGRAM DOES NOT AFFECT YOUR ELIGIBILITY AND WILL NOT GRANT YOU AN ADVANTAGE IN SCHOLARSHIPS AWARDS

o DIAGNOSIS DAY

o HEALTH OCCUPATIONS JOB SHADOWING

o MEDSTARS/HPREP CAMP

o INTER-PROFESSIONAL EDUCATION TRAINING

o OTHERS (PLEASE SPECIFY):

o I HAVE NOT PARTICIPATED IN ANY CEAHEC STUDENT PROGRAMS

SCHOOL ACTIVITIES, CLUBS, SPORTS, OR AWARDS

PLEASE LIST ANY EXTRA-CURRICULAR SCHOOL ACTIVITIES YOU MAY HAVE PARTICIPATED IN INCLUDING LEADERSHIP POSITIONS, CLUBS, SPORTS, ETC. YOUR ANSWERS SHOULD INCLUDE VOLUNTEERING EXPERIENCES, AND ACADEMIC AWARDS OR HONORS. PLEASE INCLUDE CORRESPONDING LENGTH OF PARTICIPATION AND/OR DATE OF AWARD.

THERE IS NO LENGTH REQUIREMENT OR PAGE LIMIT TO YOUR ANSWERS/LISTS.

ESSAY QUESTIONAIRE

PLEASE PROVIDE A TYPED RESPONSES TO THE FOLLOWING QUESTIONS BELOW. EACH RESPONSE SHOULD BE TYPED USING TIMES NEW ROMAN, 12-POINT FONT. PAPER SHOULD BE DOUBLE SPACED WITH 1-INCH MARGINS. EACH ANSWER SHOULD BE APPROXIMATELY HALF A PAGE.

1. WHAT PERSONAL, PROFESSIONAL OR ACADEMIC EXPERIENCE WAS MOST INFLUENTIAL FOR LEADING YOU TO PURSUE A CAREER IN HEALTH CARE?

2. WHAT ARE YOUR HEALTH CARE CAREER ASPIRATIONS AND WHY?

3. WHAT IS ONE QUALITY THAT YOU POSSESS AND BELIEVE WILL HELP YOU SUCCEED AS A HEALTH CARE PROFESSIONAL?

4. WHAT DO YOU BELIEVE WILL BE YOUR GREATEST CHALLENGE IN ACHIEVING YOUR CAREER ASPIRATIONS?

5. PLEASE DESCRIBE A CARE GIVING EXPERIENCE YOU HAVE HAD AND HOW IT HAS GIVEN YOU AN INSIGHT ON THE PATIENTS YOU HOPE TO SERVE.

6. PLEASE EXPLAIN YOUR PLANS UPON PROGRAM COMPLETION/GRADUATION AND WHY YOU ARE INTERESTED IN PRACTICING HEALTH CARE IN RURAL OREGON?

LETTERS OF RECOMMENDATION

PLEASE PROVIDE LETTERS OF RECOMMENDATION FROM TWO INDIVIDUALS WHO CAN SPEAK IN REGARDS TO YOUR POTENTIAL AS A HEALTH CARE PROFESSIONAL.

RECOMMENDER 1 NAME:

RELATIONSHIP:

CONTACT:

RECOMMENDER 2 NAME:

RELATIONSHIP:

CONTACT:

APPLICATION COMPLETION CHECK LIST

PLEASE CHECK THE FOLLOWING LIST TO INSURE YOUR APPLICATION IS COMPLETED. A COMPLETE APPLICATION SHOULD INCLUDE THE FOLLOWING:

COMPLETED HEALTH CARE SCHOLARSHIP APPLICATION FORM

MOST CURRENT UNOFFICIAL ACADEMIC TRANSCRIPT

LIST OF SCHOOL ACTIVITIES, CLUBS, SPORTS OR AWARDS

TYPED RESPONSES TO SCHOLARSHIP QUESTIONS

TWO LETTERS OF RECOMMENDATIONS IN A SEALED ENVELOPE WITH SIGNATURE OF LETTER WRITER ON ENVELOPE SEAL

APPLICANT SIGNATURE:

DATE:

PRINTED NAME:

COMPLETED APPLICATION AND SUPPORTING DOCUMENTATION SHOULD BE RECEIVED BY MARCH 19, 2020, 5 p.m.

PLEASE SEND COMPLETED APPLICATIONS TO:

PATSY DRYDEN

CASCADE EAST AHEC

ST. CHARLES MEDICAL CENTER

2500 NE NEFF ROAD

BEND, OR 97701

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What the Health Care Scholarship Application Is

The Health Care Scholarship Application is a standardized form used by educational institutions, hospitals, foundations, and nonprofits to collect applicant information, academic and clinical credentials, financial need data, and consent for review. It documents eligibility, documents supporting claims, and applicant attestations so awarding bodies can evaluate candidates consistently. Proper completion ensures timely review and preserves eligibility for funds tied to academic terms, clinical placements, or training programs. The form often includes attestations about enrollment, intended program, dates, and authorization to verify records with third parties.

Why a Complete Application Matters

A fully completed Health Care Scholarship Application speeds evaluation, reduces follow-up, and helps secure awards; it also creates a clear administrative record for compliance with privacy rules and funding terms.

Why a Complete Application Matters

Who Typically Prepares and Reviews This Form

Several roles interact with these applications — applicants, admissions or financial aid staff, clinical program managers, and compliance officers.

  • Applicants — Students, trainees, or practitioners completing eligibility, education, and financial sections for consideration.
  • Program Administrators — Review eligibility, confirm enrollment, and coordinate award disbursement or acceptance.
  • Compliance & Financial Aid — Verify documents, apply privacy controls, and ensure award terms meet funder requirements.

Clear role separation reduces errors and ensures that signatory authority and privacy controls are handled correctly.

Step-by-Step: Completing the Application

Follow these sequential steps to reduce omissions and accelerate review.

  • 01
    Prepare Documents: Gather transcripts, proof of enrollment, and ID.
  • 02
    Complete Fields: Enter requested details using specified formats.
  • 03
    Attach Support: Upload transcripts, letters, or financial documents.
  • 04
    Sign and Submit: Execute signature and send to the designated reviewer.

How to Set Up an Online Submission Workflow

Configure a predictable routing path and required fields to reduce incomplete applications and manual checks.

Field Configuration
Required Fields Mark name, DOB, program, and signature as mandatory.
Attachments Require transcripts and ID uploads in PDF or image format.
Routing Route to program admin, then financial aid, then compliance.
Notifications Enable automated email confirmations to applicant and reviewers.

Typical Submission and Review Flow

A clear flow reduces manual handoffs and preserves an audit trail for each action.

  • Applicant Submission: Uploads form and supporting documents online.
  • Automated Validation: System checks required fields and file types.
  • Administrative Review: Program staff confirm eligibility details.
  • Final Decision: Financial aid team issues award or denial notice.

Technical Requirements for Digital Completion

Use a secure document platform that supports PDF/Word uploads, audit trails, and role-based access to protect applicant data.

  • File Types: PDF, DOCX accepted.
  • Authentication: Email or SMS OTP options.
  • Integrations: Works with common LMS and SIS systems.

Common Deadlines and Processing Expectations

Timelines vary by funder; track the application, review, acceptance, and disbursement windows carefully to remain eligible.

Application Deadline:

Set by issuer; often 30–90 days before term start.

Review Period:

Institutions commonly allow 2–6 weeks for evaluation.

Award Notification:

Applicants typically notified within the stated review window.

Acceptance Deadline:

Usually 2–4 weeks from award notice; check fund terms.

Disbursement Timing:

Funds distributed before or during the term start date.

Consequences of Incorrect or Incomplete Applications

Lost Eligibility: May forfeit award.
Funding Delays: Award disbursement postponed.
Tax Reporting Issues: Incorrect info can trigger corrections.
Compliance Violations: Privacy breaches risk sanctions.
Administrative Burden: Requires manual follow-up.
Reapplication: You may need to reapply.

Data and Security Considerations

PHI Protection: HIPAA BAA required when PHI present.
Student Privacy: FERPA safeguards student education records.
Encryption: TLS 1.2/1.3 and AES-256 encryption.
Audit Trail: Timestamped signing and IP logs.
Access Controls: Role-based permissions recommended.
Certifications: SOC 2 Type II and ISO 27001 available.

Common Preparation Errors to Avoid

  • Leaving required fields blank or marked optional leads to immediate rejection or delays during verification.
  • Uploading unreadable scans, wrong file formats, or redacted supporting documents fails automated checks and slows review.
  • Mismatched names or inconsistent dates across ID, transcripts, and enrollment records trigger identity verification requests.
  • Signing in the incorrect place or using initials where a full signature is required can invalidate the application.

eSignature Provider Comparison for Scholarship Workflows

Compare typical starting prices and core capabilities that matter for processing scholarship applications and protecting applicant data.

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 Yes, 7-day trial Varies Varies Varies Varies
Bulk Send Yes Varies Varies Varies No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No

Real-World Examples of Scholarship Workflows

Examples illustrate how organizations structure applications and approvals to meet compliance and operational needs.

University Financial Aid Office

A public university centralized submission portal reduces manual checks by staff.

  • Bulk upload of transcripts via secure API speeds validation.
  • The university established a 4-week review SLA and retains audit logs for seven years to satisfy state and grant reporting requirements.

Hospital Foundation

A hospital foundation requires evidence of clinical placement prior to award.

  • Conditional award letters tied to verification reduce overpayment risk.
  • The foundation uses encrypted file transfer and retains applicant consent forms under HIPAA rules for six years.

Practical Tips to Reduce Errors and Delays

Applying a consistent checklist and automated validation reduces rework and ensures clearer eligibility determinations.

Use a Checklist
Create a one-page checklist of required docs and fields and attach to the application package for applicants.
Require Standard Formats
Ask for PDFs for transcripts and clear JPEG/PNG for IDs to ensure consistent processing by reviewers.
Validate Before Submit
Implement front-end checks for required fields, accepted file types, and signature completion to prevent incomplete submissions.
Protect Sensitive Data
Limit access by role and ensure secure storage with encryption and audit logging for PHI and student records.

Frequently Asked Questions and Common Troubleshooting

Answers address signature validity, privacy rules, and practical problems encountered during submission and review.


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