Please print or type legibly when completing this application. Neatness, completeness and overall presentation of your
application will be used in the selection process. IMPORTANT NOTE: APPLICATIONS, COMPLETE WITH ALL
ATTACHMENTS, MUST BE RECEIVED BY MARCH 15TH OF EACH YEAR TO BE CONSIDERED. (Note: High School
applications are to be submitted by November 15th )
First Middle Last
City State Zip Phone
Employer or School____________________________________________________
Future Degree/Course of Study & School Description
Work or Volunteer Experience:
Organizational Memberships & Community Service:
Awards & Honors Received:
Columbus Community Hospital – Education Department – PO BOX 1800 – Columbus, NE 68602-1800
Contact Reye Snitily, 402-562-3321 or firstname.lastname@example.org
Other Financial Aid:
Scholarship applicants must be accepted or currently enrolled in an accredited program of a recognized healthcare school.
Applicants must be residents of or attending school in the Columbus area and have at least a 2.50 Grade Point Average. It
is the intent of the scholarship donors to award these scholarships to highly qualified individuals who have a desire to use
their abilities to further serve the healthcare needs of the Columbus Community Hospital service area. Applicants will ideally
make themselves available to work at the Columbus Community Hospital as school workload permits.
□ T r a n s c r i p t—from current semester illustrating current and cumulative G P A.
□ E n r o l l m e n t V e r i f i c a t i o n: Submit a copy of your acceptance letter or other proof of
acceptance into an accredited healthcare program from a recognized college, university or other accredited
□ F u t u r e G o a l s. Submit a brief essay on a separate page identifying your career plans, dedication to
career, contributions you plan to make to your career and availability for work at the hospital.
Please check Scholarship(s) you are applying for:
□ High School Student Scholarship – The CCH High School Student scholarship was established in 2008. $300
will be awarded to a qualified high school student taking a C N A or other entry level healthcare course to support
development of our area youth.- Applications must be received by November 15th
□ The William and Barbara Gerhold Scholarship: The Gerhold scholarship was established in 2006 by long-time
residents Barbara Gerhold and the late William Gerhold. $500 will be awarded to a qualified student to help foster
educational achievement and service excellence among CCH employees (and children) in the NURSING field.
Applications must be received by March 15th
□ The George Prochaska Scholarship: The Prochaska scholarship was established in 2006 by the family of the
late George Prochaska. Two (2) $500 scholarships will be awarded to recognize educational achievement by
CCH employees (and children) in the NURSING field. Applications must be received by March 15th
□ Eagles Scholarship: The Fraternal Order of Eagles #1834 Aerie & Auxiliary Radiology scholarship was
established in 2006. $1,000 will be awarded to a qualified student in recognition of academic achievement in the
study of the RADIOLOGY field. Applications must be received by March 15th
□ The H D R Scholarships: The HDR scholarship was established in 2006.
□ $500 will be awarded to recognize qualified students enrolled in a healthcare program at Central Community
College. Applications must be received by March 15th
□ $500 will be awarded to a qualified student who is fluent in Spanish to support service excellence to our Hispanic
Community. Applications must be received by March 15th
Signature of Applicant: Date