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SBL Fayette County Hospital

SBLFCH Auxiliary Scholarship Application

Be sure to follow all directions carefully and supply all the requested information. Incomplete applications will not be considered.

Applications including all attachments must be received no later than April 19, 2024.

Please read carefully the information below:

I. Eligibility for Scholarship: 

  1. Any person accepted into or currently enrolled in a healthcare professional curriculum is eligible to apply. Preference will be given to students who have been accepted in a college program.
  2. Applicants enrolled in an associate degree or hospital-based program will be considered.
  3. Applicants must be a permanent resident of Fayette County.
  4. The school to be attended need not be an Illinois institution; however, it must be accredited or recognized as an approved program by the appropriate agencies.
  5. In order to be competitive, a 3.0 GPA out of 4 points or a 4.0 GPA out of 5 points is desirable.

II. Facts Pertaining to Scholarship: 

  1. SBLFCH Auxiliary scholarships are given on an academic year (four quarters or two semesters) and are based on a student's scholastic achievement, financial need and the availability of funds.
  2. If a recipient drops out of school while the award is in effect, funds must be returned commensurate with the school year remaining. For example, for one-half of the academic year, one-half of the award must be repaid.
  3. Selection of recipients is made in April. All applicants will be notified of the committee's selections.

III. Applicant's Responsibilities: 

Submit completed application along with all required attachments listed below by April 19, 2024. Be sure to gather all information prior to starting the application. The application must be completed at one time. Paper copies of the application will not be accepted.

  • At least two current letters of reference selected from teacher, counselor, employer, supervisor or clergy. 
  • Profile of yourself, stressing factors relevant to your occupational choice and goals. Include qualification you feel you have to pursue your education in your chosen profession. Limit to one typewritten page.
  • Most recent OFFICIAL transcript. If your college uses a transcript service, it can be mailed to:

SBL Fayette County Hospital
650 W. Taylor Street
Vandalia, IL 62471
Attn: Auxiliary

Questions may be directed to the SBL Fayette County Hospital Auxiliary
at 618-283-5444 or by e-mailing sheri.hopkins@sblfch.org .

LEGAL CONSIDERATIONS

Due to changes resulting from the Tax Reform Act of 1986, scholarship funds no longer are considered exempt from income tax for recipients. If the funds are used only for tuition and books at an accredited technical or vocational program, the recipient is not liable for additional income tax.

Under any other circumstances, the scholarship is treated as income to the recipient. In an employee benefit tuition reimbursement program, the funds are treated as taxable income.

Due to changes resulting from the Tax Reform Act of 1986, any funds received from the SBL Fayette County Hospital Auxiliary will be paid directly to your educational institution.

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Personal Information

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Educational Information

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Check one
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Month/Year
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Name/Address/Degree/Year Graduated
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Occupational Information



Job 1: Employer, Job/Duty, Dates from/to

Job 2: Employer, Job/Duty, Dates from/to

Confidential Information

If you are claimed as a dependent on your parent’s income taxes, please complete questions 1a-2f. If not AND you are married, skip to section 3a. If not a dependent OR not married, skip to section 4a. After completing applicable sections, continue onto sections 5 AND 6.



Company



Company

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Company


Company

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If applicable



6. Below, list your resources and anticipated expenses for the coming school year.

EXPECTED FINANCIAL RESOURCES TO BE APPLIED TO EDUCATIONAL EXPENSES

(Estimated per academic year)


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(From your employer - ex. tuition reimbursement)
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(Specify)
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Educational Expenses

Per academic year. Please do not include housing expenses. This information can be found on your school's website.

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AS PART OF YOUR APPLICATION, PLEASE SUBMIT

• Two current letters of reference selected from teacher, counselor, employer, supervisor or clergy. • Profile of yourself, stressing factors relevant to your occupational choice and goals. Qualification you feel you have to pursue your education for your chosen profession, limit to one typewritten page. • A pdf of your latest OFFICIAL transcript. If your college uses a transcript service, please upload a note stating transcripts will be mailed.

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CONSENT FOR RELEASE OF INFORMATION

I hereby consent to the release of any information in connection with the foregoing that in the sole judgement of the SBL Fayette County Hospital Auxiliary may be of assistance in evaluating my scholarship application. I hereby waive any confidentiality with respect to such information, since it is my understanding that the information will be used solely for the evaluation of my scholarship and for no other purpose.

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