Summerville Medical Center/Berlin G. Myers Scholarship 2003
Overview:
There will be one (1) $1,000 scholarship awarded to one high school senior who has permanent residence in Dorchester County and four (4) $1000.00 scholarships awarded to four (4) college students who have permanent residence in Dorchester County. These scholarships will be awarded to students who will be enrolling or who have a declared major in a medical related profession.
The high school winner MUST be a senior attending a Dorchester, Berkeley, or Charleston County high school. The winner MUST begin college in the fall semester of the year of the award. (i.e. winner announced in the Spring of 2003 would be eligible to receive the funds in the Fall of 2003).
The winner of the college level scholarship must be presently enrolled and attending Trident Technical College, Charleston Southern University or MUSC and must attend one of these schools in the Fall semester of the year of award (i.e., if wins in Spring of 2003, must attend college in Fall 2003).
The scholarship will be deposited in an account in the winner’s name at the designated college/university and can be used to pay for tuition and/or books ONLY. No portion of the award can be used toward the expense of housing or any other non-tuition/text expenses. No cash awards are available and any unused portion due to failure to continue and/or complete the college education will be refunded to the Summerville Medical Center to be used toward other scholarship awards. To assure no conflict of interest, no immediate relative of any Trident Health System Administrator, Director, or manager or relative of Mayor Myers or relative of any member of a particular year’s selection committee will be eligible for this award.
Eligibility Criteria for ALL applicants:
· Permanent resident of Dorchester, Berkeley or Charleston County for at least one year as validated by applicable proof of residency (For example: utility bill dated January of the preceding year). The year shall be determined to be the full calendar year preceding January of the spring of graduation. (i.e., Jan 1, 2003 to Dec 31, 2003). The student must reside full time in Dorchester County.
· Nomination by school official such as guidance counselor, principal, advisor or teacher along with endorsement by at least one other school official.
· Evidence of participation in school activities that support community service and good citizenship.
· Evidence of community service projects that support community and promote good citizenship.
· Personal essay describing personal goals and qualities that would make the student a deserving recipient of this scholarship.
Eligibility Criteria for HIGH SCHOOL Applicants:
· Registered as a high school student for the full senior year at any Charleston, Dorchester, or Berkley County schools.
· Successful completion of an academic course of study and anticipated completion of all required course credits toward graduation for a SC high student. (As certified by school guidance counselor)
· Minimal score of 1000 on SAT. (As certified by school guidance counselor and copy of SAT scores)
· Registration and preliminary acceptance in a college program that will lead to a career in a health care related profession. (Letter of acceptance must accompany application.)
Eligibility Criteria for COLLEGE Applicants:
· Applicant must be presently enrolled and attending Charleston Southern University, MUSC or Trident Technical College.
· Course of study must lead to a health-related career. (i.e., Nursing, Pharmacy, Medical Imaging, Laboratory Services)
· Applicant must have completed one (1) semester of study towards a degree in a medical related field.
Application Process:
All qualified students must complete the application form and submit all required documentation to:
Trident Health System
ATTENTION: Human Resources, VP, Human Resources
9330 Medical Plaza Drive
Charleston, SC 29406
1-843-797-4140
Applications must be postmarked no later than April 18, 2003 and the finalist will be notified by May 16, 2003.
Selection/Award Process:
The selection will be based on the overall student qualifications and references provided. The selection will be made by a committee that will include two administrative representatives from Trident Health System, one representative from the town of Summerville Mayor’s office, and one at-large representative from the business community (to be determined each award year).
Application Form:
Summerville Medical Center/Berlin G. Myers Scholarship
Name: __________________________________________________________________
Last Name First Name Middle Name
Address: __________________________________________________________________
____________________________________________ ZIP ______________________
Phone #: ________________________ (Home) ________________________ (Work, if applicable)
Social Security Number: __ __ __ - __ __ - __ __ __ __
Father’s Name: ____________________________________________________________
Last Name First Name Middle Name
Address: __________________________________________________________________
_________________________________________________ZIP _________________
Phone #: ________________________ (Home) ________________________ (Work, if applicable)
Mother’s Name: ____________________________________________________________
Last Name First Name Middle Name
Address: __________________________________________________________________
_______________________________________________ ZIP ___________________
Phone #: ________________________ (Home) ________________________ (Work, if applicable)
High School: _______________________________________________________________
Address: ________________________________________________________ ZIP ________
Colleges Applied to/accepted _______________________________________________
OR _______________________________________________
College Presently Attending _______________________________________________
High school applicants, please provide a copy of acceptance letter(s) with application packet.
College applicants, please provide a letter of attendance with applicant packet.
I certify that I have read and understand and accept the terms of the Summerville Medical Center/Berlin G. Myers Scholarship and agree to abide by the terms as presented. I understand the award MUST be used for tuition/books and will be deposited in an account in my name at the college/university designated. I understand that I must complete consecutive semesters/quarters of study and that failure to do so will result in forfeiture of any remaining funds. I attest that all information provided is accurate and factual and acknowledge any false information will result in elimination from consideration and/or forfeiture of the award should I be awarded the scholarship and be found to be in default for any of the information provided.
__________________________________________ __________________
Student Applicant Date
__________________________________________ __________________
Parent/Guardian (High School Applicant only) Date
Guidance Counselor/Advisor Certification
Student Name: _________________________________________________________
Last First Middle
Registered as a student in this school for entire senior year? _______Yes ______ No (High school applicants only)
Anticipated Graduation Date: ____________________________________________________
SAT Scores: ____________Verbal _____________ Math _______________ Total (High school applicants only)
Total Credits as of 12/31/02: ____________________
Total Credits as of Anticipated Graduation Date: ____________________
Class Rank: ________________ GPA: _____________
Course Summary: HIGH SCHOOL APPLICANT
Freshman
Sophomore
Junior
Senior
I certify the above information: ___________________________________________________________
Guidance Counselor Name/Signature
Date: _________________________
Course Summary: COLLEGE APPLICANT
COURSES
DATE COMPLETED
CREDIT HOURS EARNED
I certify the above information ____________________________________________________________
College Advisor Name/Signature
Date:________________________
Student Activities Summary
1. Please list all club memberships, years of participation, offices held, etc:
Club/Organization Name
Years participated/offices held
1. Please list all community service activities in which you participate or have participated.
Community Organization /Event Name
Years participated/offices held
1. Please list any honors, special recognition you have received:
Honor/Recognition
Year awarded
Student Reference Form
Student Name: _________________________________________________________
Last Name First Name Middle Name
College accepted to or attending: ____________________________________________ _______________________________________________________________________
Anticipated Graduation Date: _______________________________________________
Name of Person Providing Reference: _________________________________________
Title: _____________________________ Phone # _________________(W) __________________ (H)
Years you have known applicant: _________________
Please provide a summary as to why the above-named individual should be considered as this year’s recipient for the Summerville Medical Center/Berlin G. Myers Scholarship. Include any special qualities that set this student apart from his/her peer group especially in the areas of leadership, citizenship, and community service. You may provide your reference on this form or attach a separate document. You may return the reference to the student for inclusion in the packet or you can return directly to:
Trident Health System
ATTENTION: Human Resources, VP, Human Resources
9330 Medical Plaza Drive
Charleston, SC 29406
1-843-797-4140
