University of the Incarnate Word

University of the Incarnate Word2012-2013 Baptist Health Foundation ScholarshipApplication PacketDear Applicant:The UIW Office of Financial Assistance is pleased to announce that we have partneredwith the Baptist Health Foundation of San Antonio to provide scholarships for graduatestudents enrolled in certain health profession fields.The general information on the next page outlines the criteria for application, review andawards through this scholarship program.This is a one-time scholarship. Applicants who have received a scholarship through thisprogram in the past may reapply for funding for the 2012-13 academic year if they meetthe eligibility criteria; but renewal funding is subject to departmental approval. A newscholarship application packet must be completed and submitted in order to apply forrenewal funding.If you have questions or need additional information regarding this scholarshipopportunity, please contact me directly.Thank you,Desiree Kornrum-ByrneDesiree Kornrum-Byrne, Ph.D.Assistant DirectorOffice of Financial AssistanceUniversity of the Incarnate Word4301 Broadway, CPO 308San Antonio, Texas 78209Tel. 210-805-1233Email: kornrumb@uiwtx.edu

General Information – Baptist Health Foundation Scholarship2012-13(1) Applicants must be: US Citizens Enrolled full-time as a graduate student in one of the approved programs (MSNutrition, MSN, DNP, PharmD, OD, DPT) Must meet UIW’s GPA requirements for good academic standing Must have a 2012-13 FAFSA on file with the UIW Office of Financial Assistanceand must demonstrate financial need for funding (if selected for verification,verification process must be complete) and Must reside within the Baptist Health Foundation’s service area (approvedcounties of residence include: Atascosa, Bexar, Bandera, Comal, Guadalupe,Kendall, Medina and Wilson).(2) Applicants must submit the completed application packet (release of informationform, application, essay, resume, and letter of thanks) to the UIW Office of FinancialAssistance at the address listed below by no later than 5:00 p.m. August 1, 2012.Faxed and/or emailed copies of this application are acceptable.Office of Financial AssistanceUniversity of the Incarnate Word4301 Broadway, CPO 308San Antonio, TX 78209(3) Thank you letters must be attached to the application (do not send your letterdirectly to the foundation). Please address (but DO NOT mail) your “Thank you!”to:Scholarship CommitteeBaptist Health Foundation of San Antonio750 East Mulberry Avenue, Suite 325San Antonio, Texas 78212-3107(4) Completed applications will be reviewed by UIW representatives. Students will benotified via email to their Cardinal email account if the application is approved ordenied.(5) Award values vary based on need and availability of funding. If you are approved forthis scholarship, funding will be applied to your UIW tuition and fee account in lateAugust or early September of 2012. All funds will be posted towards Fall 2012charges.

2012-2013BAPTIST HEALTH FOUNDATION OF SAN ANTONIOSCHOLARSHIP APPLICATIONPlease print or type.Name: __________________________________________________________________________________________Last First MiddleID: _____________________________________________________________________________________________UIW Student IDSocial Security NumberPermanent Address: _______________________________________________________________________________Street City State ZipIs this address in: _____Bexar County _____Comal County _____Guadalupe County _____Wilson County_____Atascosa County _____Medina County _____Bandera County _____OtherE-mail: __________________________________ Telephone #:___________________________________________Program: _____MS Nutrition _____MSN _____ DNP _____PharmD _____OD ____Post-Professional DPTAre you a U.S. citizen _____yes _____ noDo you plan to work in the San Antonio area after graduation? _______________________________________________Have you completed a FAFSA for 2012-13? ______ yes______ noFOR OFFICE USE ONLYEFC _______________ Department Recommendation:COA _______________ Recommended for Funds _____yes _____noNeed _______________ Recommended Award $_______________GPA_______________Committee Chair, please submit a copy of this page to Desiree Kornrum-Byrne, Office of Financial Assistance,CPO 308, FAX 805-1233, email kornrumb@uiwtx.edu.RETURN THIS APPLICATION TO THE OFFICE OF FINANCIAL ASSISTANCE, UNIVERSITY OF THE INCARNTE WORD,4301 Broadway CPO 308, San Antonio TX 78209, FAX 210-283-5053Rev. 06/2012

PART I – Reason for RequestFully explain your financial reasons for requesting a scholarship from the Baptist Health Foundation of San Antonio. Youmay attach a separate page if necessary. Baptist Health Foundation of San Antonio will follow the financial aidqualification guidelines established by the scholarship recipient’s institution.PART II – Student NarrativeStudents requesting a Baptist Health Foundation of San Antonio Scholarship must attach a separate page explaining whythey are pursuing a career in health care. Also include examples of your volunteer activities or other activities which helpimprove our community.Check here if you are a past scholarship recipient. Please answer the following questions on a separate page:‣ What impact did last year’s scholarship have on your studies?‣ Were there any changes in your studies last year that gave you a new perspective on your future healthcarecareer?PART III – Information WaiverI agree to a waiver that allows my school to use the Free Application for Federal Student Aid (FAFSA) information for thisscholarship.PART IV – Disclosure and ConsentI understand that falsification of any records or documents submitted to obtain this scholarship will result in my having torepay the amount granted in full to the Baptist Health Foundation of San Antonio. I certify that all of the informationprovided by me on this application is correct. I also understand that the courses taken and grades earned during thescholarship period will be reported to Baptist Health Foundation of San Antonio at the conclusion of the funded semester.Today's Date:Applicant's Signature:RETURN THIS APPLICATION TO THE OFFICE OF FINANCIAL ASSISTANCE, UNIVERSITY OF THE INCARNTE WORD,4301 Broadway CPO 308, San Antonio TX 78209, FAX 210-283-5053Rev. 06/2012

University of the Incarnate Word2012-2013 Scholarship Release of Information FormThe University of the Incarnate Word makes every effort to protect the privacy of youreducational records. Scholarship donors very much appreciate knowing the students whodirectly benefit from their scholarship funds. By allowing the University to release yourname, directory, and academic information (grades and enrollment), you are helping us toconnect donors with our students. This simple act helps to ensure that more UIWstudents will continue to benefit from these generous gifts.By signing below you indicate:___you authorize UIW to release your name, directory and academic information(grades and enrollment) to the Baptist Health Foundation in conjunction with anyscholarship you may receive from the foundation.OR___you do not authorize UIW to release your name, directory and academicinformation (grades and enrollment) to the Baptist Health Foundation inconjunction with any scholarship you may receive.______________________________________________ _______________________SignatureDate______________________________________________ _______________________Printed NameUIW ID or SocialThis form must be submitted with the scholarship application.The application and all accompanying forms and documents must be submitted to theUIW Office of Financial Assistanceby 5:00 p.m. August 1, 2012.