A Resident of Hood County And/Or Pecan Plantation Or Current Employee of LGMC

LAKE GRAN BU RY M E D ICA L C E N T E R

1. Applicant must be: a. A resident of Hood County and/or Pecan Plantation or current employee of LGMC. b. Pursuing a career in the health care field.

c. Able to demonstrate financial need. d. Aware that preference will be given to past recipients who have completed one year of college. 2. Applicant must complete the attached application and return the application and all requested documentation by April 07, 2017. Incomplete applications and failing to submit requested documentation will i nvalidate the p rocess. 3. Applicant is subject to a personal interview. 4. All applicants will be notified by the Scholarship Committee regarding the committee's decision. 5. A scholarship of $2000.00 ($1000.00 per semester) will be paid directly to the institution you will be attending. It is to be used in the fall, spring, or summer semesters. 6. A transcript of grades is required before money for each semester will be issued. Failing grades will automatically cancel the remainder of the scholarship. A recipient is expected to maintain a "C" average in order to receive funds. 7. Recipient may be asked to speak to the Auxiliary once during the year. 8. Should the recipient fail to complete the semester covered by the award, the recipient shall be required to repay LGMCA the amount awarded. A signed agreement will be required at the time the scholarship is granted. 9. The applicant shall be required to enroll as a full-time student in an accredited University (12 hours is considered to be full-time.) 10. Scholarships are not automatically renewed. You must re-apply yearly. Documentation Required: To be considered a viable applicant, it is vital that all documentation be turned in at one time. Please Print L egibly.

1. Official application 2. A letter stating the reason you are applying for the scholarship and the goals you have set. 3. Three (3) letters of recommendation (preferably from employer, teacher, and personal friend.) Past recipients are only required to furnish one letter of recommendation: preferably from a professor. 4. Current photograph 5. Copy of driver's license 6. Last current transcript for high school senior, last semester transcript for college students.

Seal all the above in an envelope marked "Scholarship Committee" and return to the LGMC Gift Shop or mail to:

LGMC Auxiliary Tink Tuggle C/O Scholarship Committee; Gift Shop 1310 Paluxy Road Granbury, TX 76048 Please Print Le g ll2.!Y

LIMITED TO STUDENTS ENROLLED OR PLANNING TO ENROLL AS A FULL-TIME STUDENT IN A HEALTH CARE FIELD - DEADLINE IS APRIL 07, 2017

Application Photo Letter _ Recommendations DL College Student ID#

Name ------

Address City I Zip _

Telephone SS # ------

Email address. Alternate phone # · _

Age Date of Birth ------U.S. Citizen ------

) Single ) Divorced Marital Status ( ( ) Married ( ) Widowed

Education, _ Year Graduated High School _

If high school student, please give SAT/ACT Scores ------

College or Institute you are attending or plan to attend: ------

Address . _

Current Classification GPA _ ) High School ) College Degree or Program you plan to pursue ------

List your most recent extra-curricular and/or community activities _

Financial need is a determining factor in selecting candidates for scholarship. This information will be kept in strict confidence. Please list the income of the responsible party (s) as listed on last year's tax return.

_ $0 - $50,000 _$50,000 - $75,000 _ $75,000 - $100,000 _ Above $100,000

Are you currently receiving financial aid in the form of scholarships, student loans or grants? If yes, please explain: _

Do you have siblings currently attending a college or university? ( ) No ) Yes ( If so, how many? _

Date _ Signature _

If you currently do not have your college ID #, we must receive it before funds will be issued. Please forward it to us as soon as you receive it. Lake Granbury Medical Center Auxiliary Scholarship

Printed Name

I understand the provisions of the scholarship I am receiving from your organization as stated below:

1) The scholarship of 2,000.00 (1,000.00 per semester) will be paid directly to the institution I attend. It is to be used in the fall, spring and /or summer semester. 2) I will be enrolling in an accredited institution as a full time student pursuing a career in a health care field. (12 hours is considered to be a full time) A transcript of grades will be required at the end of each semester. I am required to maintain no lower than a "C" average. Failing grades will automatically cancel the scholarship. Funding for the next semester will be cancelled if compliance is not met. 3) If this is my final college semester, I understand that my transcript must be forwarded to the Auxiliary as required. 4) Should I fail to complete the semester covered by the award, have failing grades or fail to produce my transcript, I shall be required to repay LGMC Auxiliary the amount awarded.

My signature below indicates that I understand and agree to these provisions.

Date _ Signed:

I am requesting scholarship funds for: (Check one or two semesters that apply)

Fall Semester: 2017 Spring Semester: 2018 Summer Semester: 2018