University of the Incarnate Word

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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.
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University of the Incarnate Word

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