Name: Hamot Health Foundation
Price range: $

Scholarship applications are accepted February 1 - March 31 each calendar year. Please check back next year for additional opportunities.

Fields marked with are required.

I am applying for a:

Applicant Information

First Name

Middle Initial

Last Name

Address

City

Dropdown 1

ZIP Code

Phone Number

Phone Type

Email

Employee ID

Employment Experience

Current UPMC Hamot Department

Job Title

Supervisor Name

Total number of years at UPMC Hamot

Job Status

I understand that Hamot Health Foundation may contact my supervisor for a reference?

Education

What is your current highest level of education completed?

Degree being sought through this scholarship request

Educational institution you are attending to seek this degree?

Date starting program

Estimated date of completion

I am just starting the program and have no transcripts available

Financial Aid Worksheet

Annual tuition for degree being sought

Do not include room & board, meals, textbooks or other fees

Amount of loans toward the program - this academic year only

Amount of other scholarships or awards - this academic year only

Do not include loans or amounts being borrowed

Estimated out of pocket tuition - this academic year only

(after loans and awards)

Statement of Understanding

If I am awarded a scholarship, I understand that I am responsible for signing and submitting a scholarship agreement after notification of my award.

I am responsible for submitting my tuition bill to Hamot Health Foundation with an outstanding balance equal or greater to the amount of my scholarship.

My scholarship will be paid directly to the educational institution I am attending.

Signature

File Attachment 1 - Professional Goal Statement

Please name file: last name -goals (ex: Smithgoals)

File Attachment 2 - Reference letter #1

Please name file last name - ref1 (ex: Smithref1)

File Attachment 3 - Reference Letter #2

Please name file: last name - ref2 (ex: Smithref2)

File Attachment 4 - Transcript

UPMC Hamot Employee Scholarship Application

Applicant Information

Employment Experience

Education

Financial Aid Worksheet

Statement of Understanding

For Corporators

For Volunteers