_HFMA_ Scholarship - The Wisconsin Chapter of HFMA by yaofenji


									        Wisconsin Healthcare Financial Management Association (HFMA-WI)
                                       Application and Instructions

1.0   Scholarship Purpose and Specifics – Up to two $2,000 scholarships will be awarded annually to
      full- or part-time college students who have at least 60 post-secondary credits. In addition to the
      monetary award, recipients, plus up to five others from the applicant pool, will receive a) paid HFMA
      student membership until graduation (two-year maximum) and b) waived registration fees for
      Wisconsin HFMA programs during the time they are a student member.

      The purpose of the scholarship is to
            Recognize contributions of those who work in the healthcare field
            Encourage healthcare finance as a field for financial professionals
            Increase the visibility of HFMA within the healthcare and overall communities
            Provide networking opportunities for students who may be interested in healthcare as a
            Make a difference in healthcare’s future

2.0   Eligibility & Verification (Verification Sheet must also be completed)

Name of Applicant ____________________________

Permanent Address _____________________________________________________________________

Email Address _________________________________              Phone Number _________________________

2.1   School

Number of credits earned = _________, as of _____________                  Currently in school Y N

Name/location of school _________________________________________________________________

GPA for last semester completed _______ (3.0 required)      Full-time or Part-time student ______________

Anticipated graduation date ________________ Degree/Major working toward*______________________

2.2   Personal

I am currently employed in a Wisconsin healthcare institution Y N

I was employed in a Wisconsin healthcare institution immediately prior to attending school Y N

One of my parents is employed in a Wisconsin healthcare institution Y N

What type of job do you intend to pursue on graduation?





HFMA-WI Scholarship 12/2007
 3.0     Essay – On a separate sheet, please write an essay of 300 words or less on one of the following
         topics. This is one of the major criteria for awarding scholarships. You are strongly encouraged to
         submit the essay electronically, even if the rest of the application is sent on paper. Make sure your
         name is on the essay.

         Essay topics

                 The role healthcare has played in my life
                 How I would change healthcare in the United States
                 Why I want to work in healthcare
                 The future of healthcare in the United States

4.0    Questions and Submission – Questions about this form or the scholarship program can be
       addressed to Bruce Lorenz (lbrucelorenz@gmail.com) or 715 218-8575. The email (preferred) and
       USPS addresses for completed applications and required materials are:

                  E-Mail: lbrucelorenz@gmail.com

                  Wisconsin HFMA Scholarship Committee
                  Bruce Lorenz
                  307 West Central Entrance
                  Duluth, MN 55811

       *Eligible majors are accounting, business, economics, finance, public health, public policy, or a related
       degree. If the degree is not one of those specified, you may wish to submit a short paragraph
       explaining why you feel the degree is “related” to one of those specified. Preference will be given to
       those who demonstrate an interest in obtaining a position in healthcare after graduation. The
       scholarship is not for clinical providers of healthcare services, i.e. nursing, physician
       assistant, etc.

HFMA-WI Scholarship 12/2007
                                 Verification Sheet – WHFMA Scholarship

1) Attach a copy of your most recent college transcript. This does not need to be an official transcript, as
long as it is on school letterhead or from the school website and includes:

           Name of Student, along with address, social security number, or some other identifier
           Classes taken, credits earned, and grade point average
           Enrollment dates

2) Healthcare Employment Verification – To be filled out by Human Resource Department of the
qualifying Wisconsin healthcare institution (defined as a hospital, skilled nursing facility, nursing home,
home health agency, or clinic.)

Student qualifies based on employment of              Self        Parent

Name of Student_________________________________________

Name of Parent (if applicable) _______________________________

Name/Address/Phone of Wisconsin healthcare institution



To be filled out by Human Resource Department of qualifying Wisconsin healthcare institution.

The student/parent above was/is employed by us from _______________ to _______________.

_______________________                    ________________________                    _________________
Signature                                  Title (please print)                        Date


3) Letter of Reference – This is to be completed on a separate sheet of paper by someone who is not a
family member (usually a teacher or an employer.)

Signature/Date of Applicant _____________________________
(By signing, you authorize the WHFMA Scholarship Committee may make any inquiries needed to verify the facts in this

HFMA-WI Scholarship 12/2007

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