RANSOM MEMORIAL HOSPITAL AUXILIARY
SCHOLARSHIP APPLICATION
INSTRUCTIONS

If you are a DEPENDENT student (still on parents taxes) please skip Section 3.

If you are an INDEPENDENT student (age 24 or above, married, veteran, have a child of your own) please skip Section 2.
SECTION 1
Name:
Date of Birth:
 
Age:
Social Security Number:
Phone:
Home Address:
Cell Phone:
City:
  
State:
Zip:
Current Address (if other than above):
 
Phone:
Franklin County Resident (yes/no):  Current RMH Employee (yes/no): 
   
SECTION 2
Parents or Guardian:
Occupations: Father
Mother:
SECTION 3
Marital status:
 Children: Number:
Ages:
Spouse’s Name:
 Spouse’s Occupation:
SECTION 4
Schools attended (beginning with High School):  
From:
To:
GPA:
From:
To:
GPA:
From:
To:
GPA:
School that you plan to use this scholarship:
Date that you plan to enroll:
Major course of study:
   
 Signature: ______________________________________ Date: _______________
BIOGRAPHICAL DATA
for the
Ransom Memorial Hospital Auxiliary Scholarship

INSTRUCTIONS

Please answer these questions in order on a separate sheet and attach to the application sheet. (Limit 2 pages)

A. Offices and positions of leadership held in school and/or community:

B. Position held in gainful employment, with approximate dates:

C. Honors and Awards received:

D. Activities and Hobbies:

E. Please explain why you chose your specified major and your professional goals.

F. Provide a description of why you should be the recipient of a Ransom Memorial Hospital Auxiliary Scholarship.

Return completed application, transcript(s) and
2 letters of recommendation (other than family)
by Wednesday, March 3, 2010 to:

Jody Lancaster
Director of Volunteer Services
Ransom Memorial Hospital
1301 South Main Street
Ottawa, KS 66067

Applications must be postmarked by
Wednesday, March 3, 2010 to be considered!