ASCLS Oregon Application Scholarship.final .pdf

File information


Original filename: ASCLS-Oregon Application Scholarship.final.pdf
Author: Elizabeth Smith

This PDF 1.5 document has been generated by Microsoft® Word 2013, and has been sent on pdf-archive.com on 16/10/2016 at 19:05, from IP address 71.222.x.x. The current document download page has been viewed 736 times.
File size: 158 KB (4 pages).
Privacy: public file


Download original PDF file


ASCLS-Oregon Application Scholarship.final.pdf (PDF, 158 KB)


Share on social networks



Link to this file download page



Document preview


BETSY BAPTIST SCHOLARSHIP APPLICATION
(ASCLS-OR)
SCHOLARSHIP ELIGIBILITY - GUIDELINES:
1. Applicant must be a member of ASCLS-OR.
2. Applicant must be admitted to one of the programs in Oregon: 1) the baccalaureate Clinical Laboratory
Science program at Oregon Tech-OHSU or 2) the associate Medical Laboratory Technician program at
Portland Community College.
3. Applicant must fall into one of the following categories:
Category
A
B

Description
CLA graduate or practitioner, MLT graduate or practitioner, or any student enrolled in the
baccalaureate CLS program at Oregon Tech · OHSU
Any student enrolled in the associate MLT program at Portland Community College

4. Applicant must be a U.S. citizen or permanent resident of the United States.
APPLICATION PACKAGE:
1. Betsy Baptist Scholarship Application
2. Official transcript(s) from each college/university listed in this application
3. Letter of Intent: This is a short essay of no more than 500 words describing your interest in and reasons
for pursuing a career in Medical Laboratory Science and how the scholarship will help you achieve your
career goals.
4. Two (2) Letters of Reference
5. Copy of an Admission Letter
Send the application package no later than by April 30 to Directors of Scholarships listed on Page 4.

1. APPLICANT:
Name (last, first, middle initial):

Permanent address (street address, city, state, ZIP):

Phone:

Email:

Address to send the scholarship check (if different than above):

Citizenship/Immigration status (circle one):
A. U.S. citizen

Rev.1.16

B. Permanent resident (green card holder)

1

2. CLS/MLT PROGRAM ADMISSION STATUS:
Choose scholarship category (refer to section 11. below and circle one option A. or B.):
A. CLA to CLS, MLT to CLS, or CLS student
Type of program (circle one):

A. CLS

B. MLT student
B. MLT

Name of program:

Name of school/university name:

Address of school/university program:

Program director or designee:

Program director or designee e-mail:

Anticipated graduation or completion date:
Current GPA:
3. EDUCATION, TRAINING
College/University

Dates attended

Major

Degree

4. EXTRACURRICULAR COLLEGE ACTIVITIES RELATED TO CLINICAL LABORATORY
SCIENCE:

Rev.1.16

2

Extra curricular college activities - continued
If none listed, check if you are a single parent____, or sole support of family_____, and briefly explain
your circumstances):

5. HONORS, CITATIONS:
Award name

Significance of award

Date received

6. PROFESSIONAL ORGANIZATION MEMBERSHIP:
ASCLS Membership (required)
Member ID#:
Other Scientific Societies
Society

Year joined:

Membership #

Dues paid until (mm/dd/yyyy):

Dates belonged

Offices Held

7. VOLUNTEER AND/OR WORK EXPERIENCE (list more recent first):
Employer

Rev.1.16

Position/job description

Dates of employment

3

8. ANTICIPATED EXPENSES RELATED TO COURSE WORK:
Item
Tuition and fees
Books

Amount
$
$

Specify
n/a
n/a

$
Other

$
$

Total

$

n/a

9. REFERENCES, LETTER OF ADMISSION:
Two Letters of Reference and a copy of the Admission Letter from the school (or program) to which
the applicant has been admitted must accompany the scholarship application. Letters should not be
from relatives or personal friends, but from professors, advisors, and employers who can attest to the
applicant’s academic scholarship and work ethic.
10. SIGNATURES:
I hereby certify that all information in this application is true:
Date:
Print:
Signature of applicant:

WHERE AND WHEN TO SEND APPLICATION:
Send the application packet (snail mail or e-mail) to ASCLS-OR Director of Scholarships:
Heidi Smith
10875 175th Circle NE, Apt 1805
Redmond, WA 98052.
heidi2041@comcast.net
Packet must be received by the Director of Scholarships no later than April 30.
WHEN THE RECIPIENTS WILL BE ANNOUNCED:
Recipients will be announced in May, at the ASCLS-OR Board of Directors Meeting. Scholarship funds will be
distributed to awardees in June.

Rev.1.16

4


Document preview ASCLS-Oregon Application Scholarship.final.pdf - page 1/4

Document preview ASCLS-Oregon Application Scholarship.final.pdf - page 2/4
Document preview ASCLS-Oregon Application Scholarship.final.pdf - page 3/4
Document preview ASCLS-Oregon Application Scholarship.final.pdf - page 4/4

Related documents


ascls oregon application scholarship final
spring 2016 issue
summer fall 2016
600 free scholarships for minorities updated
hbcu scholarship 2017
msu pdf link aug 2017

Link to this page


Permanent link

Use the permanent link to the download page to share your document on Facebook, Twitter, LinkedIn, or directly with a contact by e-Mail, Messenger, Whatsapp, Line..

Short link

Use the short link to share your document on Twitter or by text message (SMS)

HTML Code

Copy the following HTML code to share your document on a Website or Blog

QR Code

QR Code link to PDF file ASCLS-Oregon Application Scholarship.final.pdf