Cache Valley for Hope Cancer Foundation Cancer Survivor College Scholarship Program



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Dear Scholarship Applicant:
Cache Valley for Hope Cancer Foundation has established a scholarship program to give young cancer survivors the opportunity to pursue their post-secondary education from an accredited university, community college or vocational technical school.
The scholarship program is designed to ease the financial and emotional hardships associated with fighting cancer and to assist young cancer survivors in reaching their academic potential and fulfilling career dreams.
Enclosed is your application packet. Please carefully follow the application directions and checklist to ensure you have included all the required documents. Only fully -completed application packets received by June 30, 2018 will be considered.
Due to limited resources, the CVFH may not be able to award scholarships to all cancer survivors who apply. CVFH volunteers and staff will review applications through June, and recipients will be announced July 31, 2018.


If you have any questions while filling out the application packet, please call 435-755-3003. We wish you the best of luck in your academic pursuits.

Sincerely,


Roger Welsh

Founder, CVFH








FACT SHEET

PURPOSE:


The Cache Valley for Hope Cancer Foundation Scholarship Program gives cancer survivors the opportunity to pursue their post-secondary education from an accredited university, community college, or vocational technical school.

ELIGIBILITY:



  • Must be diagnosed with cancer or the spouse or child of a cancer patient. Applicants must be age 50 or younger at the time of application.

  • Scheduled to graduate from high school and/or continuing college in the upcoming school year.

  • Must be a U.S. citizen and a resident of Cache Valley, Utah- Southern Idaho.

  • Accepted without condition to an accredited university, college, community college or vocational technical school.

  • Must have a GPA of 2.5 or above.

  • Must be registered as a full-time student at an accredited university, college, community college or vocational technical school in the upcoming academic year.

Only those applicants who meet all eligibility requirements will be considered for scholarship awards.

AWARD:
The Cache Valley for hope Cancer Foundation Cancer Survivor College Scholarship program provides an award of $2,500 or more depending on need. Recipients can apply multiple years for a possible lifetime award of up to $10,000 per student. After the initial award, scholarship renewal in subsequent years is based on successfully meeting program eligibility requirements, continuous academic achievement, and a level of commitment as a CVFH volunteer.



Due to limited resources, the CVFH may not be able to award scholarships to all cancer survivors who apply.





CRITERIA FOR SELECTION:
All scholarships are awarded at the discretion of the CVFH volunteer scholarship committee and are based on the following weighted criteria:



    • Financial Need: [50% weight]

Factored from a composite of family/student income and assets, number in household, unpaid medical bills, others in the family attending college and other scholarships/grants.


    • Community Service/Activities: [20% weight]

Based on a composite of extracurricular activities, community involvement, honors or awards received and involvement with the CVFH.


    • Goals and Leadership Essay: [15% weight]

Composite of long-term career plans, determination to reach goals, expression and organization of thought.


    • Letters of Recommendation: [9% weight]

Based on a composite of the three provided recommendations.


    • Grade Point Average: [6% weight]


REQUIREMENTS FOR SCHOLARSHIP RENEWAL:

  • Complete the application as outlined in the application packet. Be sure to include a new essay and three letters of recommendation.

  • At least 25 hours of volunteer work for CVFH per calendar year. ALSO, submit completed Student Volunteer Form with application.

  • Maintain a minimum GPA of 2.5.

  • Enrolled as a full-time student at an accredited university, college, community college or vocational technical school.


A previous award recipient is NOT guaranteed renewal of a scholarship award.




APPLICATION DIRECTIONS

Request an application packet by calling 435-755-3003. Completed applications must be received no later than June 30, 2018 and enclosed with the following information:

  • Three letters of recommendation, including one from a teacher or school counselor, and one from a physician.

  • Essay of 500 words or less stating how a scholarship from the CVFH foundation will help further your academic career. Include your educational, occupational, and personal goals in the essay. Typewritten essays are strongly preferred.

  • A copy of your academic transcripts from grades 9-12 and if applicable, your college/university academic transcripts.

  • Letter of acceptance to an accredited university, college, community college, or vocational technical school (when available).

  • Completed CVFH Financial Aid Form.

  • Copy of the first two pages of your parents’ (and yours if you were employed) 2014 IRS tax form.

  • Completed Student Volunteer Form (only past recipients re-applying for scholarship).



Send completed applications to: CVFH

Attention Roger Welsh

135 South Main Suite 100

Logan, UT 84321

Please do not staple or include front-to-back copies in your application packet.

Only complete applications will be considered.


APPLICATION
2018/2019 Academic Year

Received no later than June 30, 2018

Name ___________________________

Street
Address _____________________________________________________________________


City State Zip

Home Phone ___________________________ Cell Phone ________________________

E-mail Address ____________________________________________________________

Are you a U.S. citizen? Yes ____ No ____

Are you a permanent resident of Cache Valley, Utah, Southern Idaho ? Yes ____ No ____


Privacy Notice
Cache Valley for Hope Cancer Foundation (CVFH) cares about your privacy and protects how we use your information.

By providing this information, you understand and agree to let CVFH receive and share information about you which is necessary to help in processing your application.

________________________________________________________




Applicant Signature Date



Parent or Legal Guardian Signature Date

(If applicant is minor, under 21 years)

________________________________________________________
Cancer Site (if applicable)

Have you completed treatment? Yes ____ No ____

If yes, when was your last treatment?
List any long-term effects ____________________________________________________

_________________________________________________________________________
Have you ever applied for a previous CVFH scholarship? Yes ____ No ____
Have you ever received a previous scholarship from CVFH? Yes ____ No ____
If yes, what year(s)? ________________________________________________________
When will you/did you graduate high school? ____________________________________


List all secondary schools attended, including current (graduating) school:


School/Institution

Dates Enrolled

City/State

Grade Attended







































College/university/school you plan to attend:

Have you been accepted for admission? Yes ____ No ____

If not, when do you expect to be notified of acceptance?

What year will you be in college in 2017/2018?

  • First (no previous college)

  • First (previous college)

  • Second

  • Third

  • Fourth

  • Fifth (or more undergraduate)

Where do you plan to live?

  • On Campus

  • Off Campus (not home)

  • Home

  • Unsure

  • Other

Estimated total cost of tuition and books in 2018/2019: ____________________

GPA from your most recent quarter/semester of school? (high school or college) __________

Note: You must include a copy of your most recent transcripts. They do not need to be official copies.

List any school related activities, volunteering/community service or employment.

List your personal interests and hobbies outside of school.

Briefly state your reasons for needing this scholarship.

Essay: Write an essay (500-word maximum) stating how a scholarship from the CVFH will help further your academic career. Include your educational, occupational, and personal goals in the essay.
How did you hear about the CVFH Survivor College Scholarship program?


  • Physician/Hospital Staff

  • High School

  • Media, Newspaper or TV

  • Friend/Family

  • Internet

  • CVFH Volunteer or Staff

  • Other



FINANCIAL AID FORM

STUDENT INCOME

Student’s Adjusted Gross Income in 2017

Student’s untaxed income/benefits in 2017
Will the student work during the summer and/or 2018/2019 school year?

Yes ____ No ____


Student’s expected summer (2018) and school year (2018/2019) income

Please list any outstanding medical bills not covered by insurance.

­­­­­­­­­­­­­­­­­­­­­________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

Other scholarships or grants received:

Amount

Terms of Scholarship




Scholarship








































STUDENT ASSETS

Total (cash, savings, checking) account balances $__________

Total value of all investments $__________

Employer



Number of years ____________

PARENTS’ ASSESTS

Total (cash, savings, checking) account balances $______________

Total value of all investments $______________

Value of home (renters write in “0”) $______________ Amount owed on home? $_____________

Other real estate $_______________________ Amount owed on other real estate? $

Are there any special financial circumstances that you would like to add?

Note: Applicant must attach a copy of the first two pages of parents’ (and applicant’s if employed) 2016 IRS tax form; either 1040, 1040A, or 1040 EZ.

TEACHER OR SCHOOL COUNSELOR RECOMMENDATION

This recommendation is for a scholarship sponsored by the CVFH for young cancer survivors in Utah. A committee of volunteers will evaluate each applicant to determine winners. Your comments will help provide a more complete picture of the student for the committee’s consideration. Thank you for your assistance.

Name of Scholarship Applicant ______________________________________________ Date_____________________

Directions: The following is to be completed by the person making the recommendation, and must be attached to a letter of recommendation.
What are the first three words that come to mind in describing the applicant?
_____________________________ ________________________________ ___________________________

In comparison with other students you have known, please rate the applicant by circling a number from 1 to 5, with 5 being the highest ranking.

Academic Motivation 1 2 3 4 5 no basis for judgment

Academic Potential 1 2 3 4 5 no basis for judgment

Creativity 1 2 3 4 5 no basis for judgment

Self-Discipline 1 2 3 4 5 no basis for judgment

Leadership Skills 1 2 3 4 5 no basis for judgment

Initiative 1 2 3 4 5 no basis for judgment

Reaction to Adversity 1 2 3 4 5 no basis for judgment

Analytical Ability 1 2 3 4 5 no basis for judgment

Oral Communication 1 2 3 4 5 no basis for judgment

Classroom Participation 1 2 3 4 5 no basis for judgment

Written Communication 1 2 3 4 5 no basis for judgment

Independence 1 2 3 4 5 no basis for judgment

Problem Solving 1 2 3 4 5 no basis for judgment



QUALITY RATING



Your Name ___________________________________
Work Phone ______________________________ Home Phone __________________________


Signature
___________________________________

PHYSICIAN RECOMMENDATION

This recommendation is for a scholarship sponsored by the Cache Valley for Hope Cancer Foundation for young cancer survivors in Cache Valley. A committee of volunteers will evaluate each applicant to determine winners. Your comments will help provide a more complete picture of the student for the committee’s consideration. Thank you for your assistance.

Name of Scholarship Applicant __________________________________ Date ______________

Date of Diagnosis __________________________

Personal Comments

_____________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

In comparison with other students you have known, please rate the applicant by circling a number from 1 to 5, with 5 being the highest ranking.


Creativity 1 2 3 4 5 no basis for judgment

Self-Discipline 1 2 3 4 5 no basis for judgment

Initiative 1 2 3 4 5 no basis for judgment

Reaction to Adversity 1 2 3 4 5 no basis for judgment

Oral Communication 1 2 3 4 5 no basis for judgment

Independence 1 2 3 4 5 no basis for judgment

Problem Solving 1 2 3 4 5 no basis for judgment


QUALITY RATING

Your Name ___________________________________

Work Phone __________________________ Home Phone __________________________

___________________________________




Signature



RECOMMENDATION

This recommendation is for a scholarship sponsored by the CVFH for young cancer survivors in Utah. A committee of volunteers will evaluate each applicant to determine winners. Your comments will help provide a more complete picture of the student for the committee’s consideration. Thank you for your assistance.

Name of Scholarship Applicant _____________________________________________ Date _____________________

Directions: The following is to be completed by the person making the recommendation and attached to a letter of recommendation.

What are the first three words that come to mind in describing the applicant?

____________________________ ______________________________ ___________________________

In comparison with other students you have known, please rate the applicant by circling a number from 1 to 5, with 5 being the highest ranking.

QUALITY RATING

Academic Potential 1 2 3 4 5 no basis for judgment

Creativity 1 2 3 4 5 no basis for judgment

Self-Discipline 1 2 3 4 5 no basis for judgment

Leadership Skills 1 2 3 4 5 no basis for judgment

Initiative 1 2 3 4 5 no basis for judgment

Reaction to Adversity 1 2 3 4 5 no basis for judgment

Analytical Ability 1 2 3 4 5 no basis for judgment

Oral Communication 1 2 3 4 5 no basis for judgment

Independence 1 2 3 4 5 no basis for judgment

Problem Solving 1 2 3 4 5 no basis for judgment





Your Name _____________________________________________________


Phone Number ___________________________________________________
Relationship to Applicant _____________________________________________________________________



Signature
_________________________________________

Cache Valley for Hope Cancer Foundation

Cancer Survivor College Scholarship Program

APPLICATION CHECK LIST
Be sure the following are enclosed:



      • Completed Application Form




      • Three recommendations (including one from a teacher or school counselor and one from a physician)




      • Goal statement/essay of 500 words or less




      • Copy of most recent academic transcripts




      • Letter of acceptance to a post-secondary institution



      • Completed CVFH Financial Form




      • Copy of the first two pages of parents’ most recent IRS tax form (applicant’s also required if employed)




      • Completed Student Volunteer Form (only past recipients re-applying for scholarship)


This form and attachments must be received no later than June 30, 2018.

Only completed applications will be considered.

Send applications to:

Cache Valley for Hope Cancer Foundation

Attn: Roger Welsh

135 South Main Suite 100

Logan, UT 84321





Recipients will be notified July 31, 2018. Payments will be sent directly to student’s school.







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