The Tidelands Health Auxiliary Healthcare Scholarship Program. Guidelines Summary and Application

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1 The Tidelands Health Auxiliary Healthcare Scholarship Program Guidelines Summary and Application Purpose and Intent: The Tidelands Health Auxiliary Healthcare Scholarship Program was created in 2008 to provide financial assistance and opportunity to further the pursuits of individuals pursuing a career in the Healthcare field. In conjunction with Tidelands Health mission, the Tidelands Health Auxiliary is proud to offer this scholarship as part of its mission to provide volunteer services in support of our Staff, Patients and Visitors by promoting health and welfare through volunteerism, community relations and other activities to support the hospital and the community it serves. Funding for the program is provided through the generosity of Tidelands Health employees, volunteers and other citizens in the local Georgetown and Horry County area through several fund raising mechanisms and programs organized and implemented by the Tidelands Health Auxiliary. The intent of this scholarship is to complement other funding sources such as Grants, other scholarships and the individual s own private funds to help with the achievement of total funding for a course of study and graduation. Eligibility - Any Tidelands Health employee who has completed the first two years course of study of a four or more year degreed program (ie: Bachelors Degree) and is currently or intends to enroll as a Full Time status student in an accredited college/university/school. Typically these students are identified as juniors or seniors. - Any Tidelands Health employee who has completed 4 years of High School, (public and/or private and intends to enroll as a Full Time status student in an accredited college/university/school. Typically these students are identified as seniors. - Current Tidelands Health employees must have satisfactorily completed the New Hire Introductory Period (typically 90-days) - This program does not discriminate on the basis, of race, age, disability, marital status, veterans status, gender, familial status, sexual orientation, religion, creed, color, national origin or any other factor and welcomes application from any and all individuals who meet these requirements. Qualified Course of Study To qualify for the scholarship individuals must pursue a course of study that is a prerequisite for, or a requirement of a position presently identified as special needs as in ADN to BSN. The need to support special positions may change over time. Tidelands Health Human Resources and the Auxiliary will identify the position listing prior to the open application distribution period each year. 1

2 Open Application Submission Period April, May and June of each year will be considered an open application period for all eligible applicants to obtain and submit applications. All applicants are encouraged to obtain the packet at the beginning of April to ensure time to complete the application and submit the application as soon as possible but not passed the June 30 deadline. The Auxiliary Scholarship Committee will conduct application reviews in April, May and June with written notification to applicants to occur no later than July 10 h. All applicants who were not awarded funding must reapply again in future years to be considered, no application will be placed on hold and there is no alternate or waiting list. Additionally, applicants who were awarded funding previously must also reapply annually there are no automatic approvals or renewals. Should a funding slot that was previously filled become vacant for any reason (i.e.: recipient exited the course of study) the funds anticipated to have been awarded will be returned to the general scholarship fund to be utilized in future years. Determination of Scholarship Recipients The Auxiliary Scholarship Committee will not utilize a first-come-first-served basis for determining recipient rankings. Determination of funding approval is based on many factors. Examples of such factors are: healthcare work force needs in relation to current or anticipated market for position in which applicant is studying. nature and purpose of Healthcare course of study in relation to current and anticipated related community position vacancies anticipated future benefits to be derived by the applicant previous high school and/or collegiate school grades and overall educational achievement other available sources to fund education relationship to current Tidelands Health employee or Auxiliary volunteer Services member consideration of any previous or current Tidelands Health educational assistance provided type of classes (virtual internet or live class) current or future residence in proximity to Tidelands Health work locations applicants overall primary motivation for seeking course of study projected pace of study and anticipated graduation date application question results letter of references and recommendation essay content results Applicant interviews For Current Tidelands Health employees: Current status (i.e.: FT, PT, PRN) Current standing as a Tidelands Health employee work and performance record department director and/or senior manager recommendation length of service with Tidelands Health 2

3 Requests for applications outside the open application period will only be granted if targeted scholarship slots are still open after consideration of all applications received by the end of the open application period. Qualified Education Expenses Payments for educational expenses will be made directly to the educational institution. Recipients are encouraged to seek qualification for other forms of educational assistance such as Pell grants, Foundation grants, other local and national scholarships, SC Lottery assistance and other private and public funding sources. Types of fees and expenses vary greatly among educational institutions. The auxiliary will make every effort to consider reasonable tuition, text books and fee expenses. Examples of expenses are as follows: Qualifying Expenses: Tuition expenses Non-Qualifying Expenses: Application fees Background check fees Uniform/clothing expenses Non-required text and materials such as notebooks, pens, pencils, binders Room and board Meal expenses Medical Insurance NCLEX study guides and courses Educational fees Cost of text books, text study guides and other specifically required text material Graduation fees Required lab fees 3

4 Number of Recipient Approved and Scholarship Amounts The Auxiliary will determine the exact number of scholarship slots as well as the value of each scholarship annually. Tidelands Health Human Resources and Volunteer Services will be notified of this information just prior to the beginning of the open application period so that this information can be shared with the applicants as applications are distributed. This decision is impacted by the availability of funds for a given year and other related factors. The auxiliary has no obligation to offer scholarships in any given year and will at its discretion make this determination with its financial advisors and after review of applications. General Program Components This section is intended to provide a detailed summary of general information. However, specific requirements and recipient obligations are noted in the Tidelands Health Auxiliary Tuition Assistance Agreement which is required to be signed by the recipient if funding is approved. - Recipients are responsible to provide proof of enrolment at any juncture requested by the Auxiliary. -Funding is intended to be made available and paid to the educational institution for the Fall semester following the open application period. Educational institution semester start dates vary and thus the Auxiliary will at its discretion determine what particular semester will be determined as the Fall semester which will be the applicable starting point for funding. -Funding is intended to be applied for one calendar year beginning with the Fall semester and ending one academic year later. Again, educational institution semester start dates vary and the Auxiliary will determine the starting and stopping point of funding at its discretion based on reasonable efforts to coincide with a Fall semester. -Recipients must maintain a B grade average for each semester. Failure to maintain a B average for one semester will result in a probationary status. Failure to maintain a B grade average for two semesters, consecutive or otherwise over the course of the agreement will result in loss of eligibility for the funding and trigger a repayment obligation of funds. -To ensure the progression through the course of study as a Full Time student and to ensure a reasonable completion time frame each agreement will have a specified date by which the recipient is required to graduate, which includes a one year buffer for unanticipated events. -In all cases the recipient has a maximum of 90 days following the date of graduation to become licensed in the State of SC. -Scholarship Recipients are invited, and expected to attend the annual Auxiliary Scholarship Reception held in July following the open application period. This is an important celebration of the Recipients and allows acknowledgment of those in the Auxiliary who have worked to provide the funding for the scholarships. Work Commitment Period -All auxiliary tuition assistance agreements require a work commitment period by the recipient with Tidelands Health upon graduation (and licensure if applicable) which will be specified in the agreement. Generally the commitment is one year of work for one year of scholarship funding. 4

5 -For recipients who are not employed by Tidelands Health, the intention is for Tidelands Health to make an offer of Full Time employment to the recipient within sixty days following graduation. If Tidelands Health fails to make this offer, the recipient is relieved from any scholarship repayment obligations to the auxiliary. This should not be construed as a promise of employment by Tidelands Health for a future job, job change/transfer. All job offers/position changes are at the sole discretion of Tidelands Health. -The specific Tidelands Health position, work location, shift and other factors related to employment will be at the sole discretion of Tidelands Health. Financial Repayment Obligation: -The recipient is responsible for repayment of funds if he or she: Fails to satisfy enrolment guidelines or maintain the B grade. Fails to Graduate and become licenses prior the expiration of the agreement. Fails to become licensed in the State of SC within 120 days from graduation date. Refuses to accept a Tidelands Health position offer of Full Time employment Fails to meet the work commitment obligation period -If a repayment obligation is initiated, the recipient will receive credit for each day worked during the work commitment period (example: If the recipient completed one half of the required work commitment period he/she would be responsible for repayment of one half the educational assistance reimbursements received from Tidelands Health) -For Tidelands Health employees, any repayment amount may be withheld from the Recipient s paycheck(s); including PTO cash-in up to the maximum amount permittable by Federal and State law. -Recipients will have thirty days to satisfy repayment obligations or make specific payment arrangements with the Auxiliary. Agreement and Practice Changes -The auxiliary will assess the need on a periodic basis to make edits to this summary or even discontinue the program. These changes will have no effect on current program recipients who have signed agreements. -In the event that there is an unanswered issue/question concerning the program components, the auxiliary will first look to the individual recipient s agreement as the rule. If the individual s agreement is silent on the issue/question then look to this summary for guidance. If there is a discrepancy or inconsistency between the agreement and this summary the agreement will always rule. Final Agreement Provisions: - This Agreement constitutes the entire understanding of the parties with Respect to the matter herein and shall not be modified except in writing, Agreed to and Signed by both parties. This Agreement shall be governed By the laws of the State of South Carolina. - Neither this Agreement nor any of its terms herein, constitutes a contract of employment, or modifies the at-will employment relationship between the parties hereto. Either Tidelands Health or the Recipient may terminate the employment relationship, With or without cause for any reason. 5

6 - Any discrepancy between current or future tuition assistance policy provisions and this agreement shall be governed by the terms and conditions of this Agreement. - If the Recipient is under age 18 at the time of the signing of this agreement A legal Parent or Guardian is required to sign the agreement resulting in binding both the recipient and the guardian to the terms of the agreement and repayment obligation. In WITNESS WHEREOF, the parties have signed this Agreement on the date and year first above written. WITNESS By: Tidelands Health Auxiliary: By: Title: Date: / / RECIPIENT: By: By: (If under age 18) Recipient s LEGAL GUARDIAN The Tidelands Health Auxiliary Healthcare Scholarship Program Application (Please review each section carefully and print clearly. Incomplete applications will be subject to potential automatic disqualification) Applications will be screened to determine the final list of applicants that will interview with the scholarship committee. These interviews will occur approximately April 1 st to June 30 th. Notification of Award Within three weeks of the interview ending period, applicants will be notified (via phone and/or and confirmed by letter) whether or not a scholarship has been granted. All questions concerning this program and application should be directed to Tidelands Health Volunteer Services at Applications must be submitted in person and date stamped in by the June 30 th deadline or mailed with a post mark by the June 30, 2017 deadline. 6

7 Applications may be mailed directly to: TIDELANDS HEALTH-VOLUNTEER SERVICES Georgetown Memorial Hospital P.O. Box 1718 Georgetown, SC Applications may be hand delivered to: a. The Volunteer Services office located at Tidelands Health Georgetown Memorial Hospital b. The Human resources office located at Murrells Inlet across from Tidelands Waccamaw Community Hospital. Date of Application / / 1a. I am a Full time student (junior/senior) at an accredited College/University/School. Yes No 1b. I am a Full time student (senior) at an accredited High School, (public and/or private) Yes No 2. I am a relative of a current Tidelands Health employee or Auxiliary /Volunteer Service member. Yes No If yes Indicate relationship 3. I am a current a Tidelands Health employee Yes No 4. I previously worked for Tidelands Health Yes No 5. I am a current Tidelands Health Volunteer Yes No 6. I am a previous Auxiliary scholarship Recipient Yes No Personal Information: Name Home Address Street City Zip Code Home Phone Mobile Phone Alternate Phone How did you hear about the Tidelands Health Auxiliary Scholarship opportunity? Education: (For any educational Diploma or certification achieved, provide a copy of diploma and transcript of courses and grades where applicable i.e. College transcripts) Last High School Diploma or Certification Received College, JC or University Diploma or Certification Received Graduate School Diploma or Certification Received Tech or Vocational School Diploma or Certification Received Other Diploma or Certification Received Yes No Yes No Yes No Yes No Yes No Other Diploma or Certification Received Yes No 7

8 Tidelands Health Volunteer Service Experience: Have you worked as a volunteer in any capacity for Tidelands Health Yes No If yes answer the remaining questions in this section: What was/is your Volunteer Title and/or assignment? To whom did you report? What was your primary Department of location assignment? Start Date of Volunteering Total Hours of volunteer service to date Previous Work Experience (provide information on your last four jobs; most recent first): 1. Employer/Company Name Last Position Held Start Date of Employment: End Date of Employment Address: Name & Phone # of the individual you directly reported to: / Description of your Work/Duties: Why did you leave? (be specific): 2. Employer/Company Name Last Position Held Start Date of Employment: End Date of Employment Address: Name & Phone # of the individual you directly reported to: / Description of your Work/Duties: Why did you leave? (be specific): 3. Employer/Company Name Last Position Held Start Date of Employment: End Date of Employment Address: Name & Phone # of the individual you directly reported to: / Description of your Work/Duties: Why did you leave? (be specific): 8

9 4. Employer/Company Name Last Position Held Start Date of Employment: End Date of Employment Address: Name & Phone # of the individual you directly reported to: / Description of your Work/Duties: Why did you leave (be specific):? Educational Plans: What is the name of the educational institution that you are currently enrolled or plan to enroll in as a Full Time Student? Have you been officially accepted as a Full Time student at this school? Yes No If No please explain Describe the type of instruction associated with your anticipated course of study (i.e.: internet based, live class room experience): What is the specific Allied Health or Nursing Course of Study that you are seeking to complete? (i.e.: BSN, PT, OT, Pharm D, RT,) How are the courses you will be taking related to a possible future job with Tidelands Health? What is your projected Date of Graduation? If you are chosen for the scholarship, provide a phone number and contact office at the educational institution that can provide payment assistance with your account: If you are chosen for the scholarship what is the address of the office at the education institution that will receive payment? If your Course of study is not being pursued at a local educational institution explain your relocation plan upon graduation and any local support you may have to help achieve your plan: 9

10 General Financial Status: Indicate educational financial funding sources that you have applied for at any time to fund any portion of past or future collegiate career: Other scholarship Approved Date Approved $ Amt Denied Applied but outcome still pending Other scholarship Approved Date Approved $ Amt Denied Applied but outcome still pending Other scholarship Approved Date Approved $ Amt Denied Applied but outcome still pending Pell Grant Approved Date Approved $ Amt Denied Applied but outcome still pending South Carolina Educational Lottery Approved Date Approved $ Amt Assistance Denied Applied but outcome still pending Other State Educational Assistance Approved Date Approved $ Amt Denied Applied but outcome still pending Federal Grant or Program Approved Denied Federal Grant or Program Approved Denied Date Approved $ Amt Applied but outcome still pending Date Approved $ Amt Applied but outcome still pending Tidelands Health Educational Assistance Approved Date Approved $ Amt Program Denied Applied but outcome still pending Employer Educational Assistance Approved Date Approved $ Amt Denied Applied but outcome still pending Provide any additional information concerning your efforts to secure financial education assistance: How will you finance the remaining portion of your educational expenses that are not covered by resources noted above? If you are not approved for this scholarship how will you finance that portion of your educational expenses? Provide any additional information concerning your ability to fund your education that you would like to bring to the attention of the Scholarship Committee? 10

11 Community, Leadership, Volunteer Activities, Essay (Do not list paid assignments or provide information that would indicate race, religion, creed, religious denomination etc.) List activities and positions of leadership that you had in school, community affairs and other: Provide information about volunteer services that you have provided in the community: Provide information on affiliation with organizations, honors received, and special interest: Describe a specific situation when you provided excellent service? Write an Essay (Attach a separate typed essay not to exceed 500 words): a. Discuss why you chose a Healthcare Course of Study and future career b. Discuss your short and long term goals c. Discuss why you feel you are a top candidate to be chosen for this scholarship I attached the essay 11

12 Additional Requirements and Check List: This list includes additional documents and information that you are required to submit along with your application as well as assists with the application completion process: 1. Provide two letters of recommendation from non-family members attesting to your academic achievement and character. Letters must be written and dated in the same year that the open application period occurs. 2. Copy of college transcripts that indicates courses completed and grades earned to date 3. If FAFSA results are available, include those with the application 4. Copy of Diploma(s) to support education achievements is attached 5. My Essay is competed and attached (see Community, Leadership, Volunteer Activities, Essay section of the application) 6. For current Tidelands Health employees, provide a letter of recommendation from your current Department Director. 7. For current Tidelands Health employees, provide a statement from TIidelands Health Human Resources indicating your current position, Department and start date (Meditech screen print will suffice). 7. I have read and signed the Applicant s Certification of Understanding and Disclosure of Information (see below): 8. I have reviewed the entire application and ensured all sections have been completed and all required attachments included. Applicant s Certification of Understanding and Disclosure of Information: By signing this application I attest that the information provided is true and complete to the best of my knowledge. I understand that and agree that any misrepresentation or omission of fact discovered will result in disqualification from consideration of future funding and termination of current scholarship with pay-back obligation (if applicable). I also understand and authorize the Tideland Health Auxiliary to conduct a check to verify accuracy of information submitted. By signing, I authorize previous employers, educational institutions, organizations and all other entities or persons named in this document that I have furnished to release from liability any and all individuals and organizations that provide information in good faith and without malice in connection with evaluation of the application and other documents and information provided. I attest that I understand that if I am selected to receive a scholarship, the money would be sent directly to the educational institution. I also agree that if awarded a scholarship, I grant permission to the Tidelands Health Auxiliary to use my name and/or picture for public relations purposed in conjunction with promoting the program Printed Name of Applicant Applicant Signature _ Date 12

13 This application when signed and submitted becomes the property of the Tidelands Health Auxiliary. Applications will be screened to determine the final list of applicants that may be interviewed with the scholarship committee. These interviews will occur approximately July 7 th. All questions concerning this program and application should be directed to Tidelands Health Volunteer Services at Applications must be submitted in person and date stamped in by the June 30th deadline or mailed with a post mark by the June 30th deadline. Applications may be mailed directly to: TIDELANDS HEALTH Volunteer Services Georgetown Memorial Hospital P.O. Box 1718 Georgetown, SC Applications may be hand delivered to: a. The Tidelands Health Volunteer Services office located at Georgetown Memorial Hospital b. The Tidelands Health Human Resources office located at Waccamaw Community Hospital 13

14 Applicant do not complete below this line For Committee use only Initial Application Screening: Application reviewed and is complete with all required attachments included? Yes No If No what s missing? Has the applicant been notified of the incomplete information? If applicant previous or current volunteer, application info under this section has been verified Yes Yes Notes: If applicant current Tidelands Health employee, info under this section has been verified and personnel file has been reviewed: Yes Notes: Name of Volunteer Service Rep screening this application (please print) Auxiliary Committee Review: Date of Auxiliary Scholarship Committee applicant review meeting? Applicant Scholarship Request: Approved Scholarship Amount $ Denied Pending Additional Information: If approved recipient signed two copies of the Tidelands Health Auxiliary Tuition Assistance Agreement, copy sent to Recipient and copy on file with the Auxiliary? Yes Applicant Recipient Communication Tracking log (indicate dates of conversations with applicant, date notified approved/denied, date payments forwarded to school etc.): 14

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