Gerry C. Gunnin, Ph.D. Scholarship in Community Health

Gerry C. Gunnin, Ph.D. Scholarship in Community Health Gerry C. Gunnin, Ph.D. 1939-2003 Gerry C. Gunnin served as President of the Presbyterian Healthcare Foundation and Vice President of the Community Health and Benefit Department for Texas Health Resources from 1995-2001. Dr. Gunnin s boundless talent and passion for community made him an irreplaceable member of Texas Health Resources Presbyterian family and his community. The Gerry Gunnin Memorial Scholarship was established to honor Dr. Gunnin s leadership and continue a legacy of advancement in community health improvement programs and activities. Purpose: To support students pursuing a graduate degree in Public Health or Community Health at a Texas accredited institute of higher learning who demonstrate financial need. Term: One Year Scholarship: Up to $6,000.00

Scholarship Application Guidelines Academic Year 2015-2016 Page 1 of 6

The Introduction Gerry C. Gunnin, Ph.D. served as President of the Presbyterian Healthcare Foundation and Vice President of the Community Health Improvement Department for Texas Health Resources from 1995-2001. Dr. Gunnin s boundless talent and passion for community made him an irreplaceable member of Texas Health s Presbyterian family and his community. The (the Scholarship ) is a tribute established to honor Dr. Gunnin s leadership and continue a legacy of advancement in community health improvement and activities. The Scholarship was instituted to assist individuals pursuing a graduate or doctorate degree in public health at a Texas accredited institute of higher learning and who demonstrate financial need and a commitment to improving the lives of others. The Scholarship consists of a single annual payment up to 1939-2003 $6,000 to be used for tuition, fees, books and other educational costs. Scholarship applicants are asked to respond to questions that reflect their commitment to community health and the communities in which they live and/or work. Guidelines Program Administration The Scholarship is administered by Texas Health Resources (Texas Health) Community Health Improvement Department. Texas Health Foundation (the Foundation ) awards the Scholarship and is responsible for all payments to scholars and schools. Applicant Eligibility An applicant must meet the following requirements in order to be eligible for the Scholarship. Enrollment in an Accredited School of Public Health in the State of Texas. The public health program must be accredited by a national accrediting agency or State approval agency recognized by the Secretary of the U.S. Department of Education. To be considered for a Scholarship award for the 2015-2016 school year, an applicant must be enrolled full-time or accepted for enrollment in a public health graduate or doctorate degree program and must begin classes for the Fall term on or after July 1, 2015, and no later than September 25, 2015. An individual planning to be on a leave of absence from school such that he/she will not begin class attendance on or before September 25, 2015, is not eligible. Page 2 of 6

Full-Time Enrollment An applicant must be enrolled as a full-time student in a graduate or doctorate program. A student will be considered full-time if the student meets the school program s definition of a full-time student. A less than fulltime student is not eligible. Proof of submission for a Student Aid Report (SAR) A funding preference is given to an applicant of greatest financial need. To evaluate financial need, the Scholarship committee will use the Department of Education's Expected Family Contribution (EFC) determination. To receive an EFC determination, applicants must submit a Free Application for Federal Student Aid (FAFSA) to the Department of Education. See http://www.fafsa.ed.gov. In response to the FAFSA, the Department of Education will provide the applicant with a Student Aid Report (SAR), which will contain the EFC determination. If you are unable to retrieve this report, please attach a statement of financial need completed by a financial advisor at the applicant s current school. Other Achievements An applicant must have a GPA of 3.5 or greater on a 4.0 scale. Other achievements will also be considered, including academic achievement, community/extracurricular involvement, leadership awards and recognition. Academic achievement includes grades, rank in class, standardized test scores, and achievement test scores. Notification of Selection An eligible applicant selected for the Scholarship will be notified by email and U.S. mail, no later than June 12, 2015. To accept the award, the applicant must respond by June 22, 2015, as outlined in the notification letter of award. An applicant selected for the Scholarship must be enrolled full-time during the 2015-2016 school year, and class attendance must begin on or before September 25, 2015. A selected applicant whose enrollment for the 2015-2016 school year will begin after September 25, 2015, MUST decline the award. To ensure timely receipt of the Scholarship communications, applicants must keep their email addresses current during the application process. To update this information, please contact the Community Health Improvement Department to by emailing RoschandaFletcher@TexasHealth.org. Notification of Non-Selection Applicants that are not selected for the Scholarship will be notified via email no later than June 26, 2015. Declining Scholarship Support An applicant selected may decline the Scholarship without penalty by mailing the Scholarship Committee a signed letter declining the award offer by June 22, 2015, as specified in the notice of award email. Once a selectee declines the offer of the Scholarship, there will not be an opportunity to reclaim the award. A selectee s decision to decline the scholarship award is final. Application Guidelines Applications for the Scholarship are to be typed or handwritten by the student. Applicants must submit the official forms included in the Application Packet. Page 3 of 6

Personal Profile Statement As part of the application process, an applicant must attach an individual statement of 750 words or less; typed and double-spaced, describing why he/she should be selected for the scholarship, with emphasis on financial need, personal goals, and community involvement. This is an opportunity for the applicant to convey specific career plans relating to a particular area of interest. Verification of Acceptance/Good Standing Report and Data Collection Worksheet for Tuition and Fees An applicant has the sole responsibility of ensuring that the worksheet is submitted and provided as part of the application packet. The worksheets must be presented to applicant in a sealed and un-tampered envelope. The envelope shall remain unopened until it reaches the Scholarship Committee. An applicant is required to use the Verification of Acceptance/Good Standing Report and Data Collection Worksheet for Tuition and Fees Form (Verification Report/Data Collection Form), which is available in the application packet. The Verification Report/Data Collection Form must be completed and signed by a University Official and bear the school s raised seal or school stamp, if the seal is not available. FAXES OR PHOTOCOPIES ARE NOT ACCEPTED. The school identified in the Verification Report/Data Collection form, submitted by April 17, 2015, will be the applicant s initial school of record. An applicant who has not been accepted for enrollment in a public health degree program and are therefore unable to provide the Verification Report/Data Collection Form by April 17, 2015, is not eligible. ONCE THE APPLICATION DEADLINE HAS PASSED, NO CHANGES WILL BE ACCEPTED IN THE APPLICANT S CHOICE OF SCHOOL OR PROGRAM PRIOR TO AWARD. An applicant who elects to enter a different school and/or program after the application deadline should contact the Scholarship Committee immediately and withdraw their application. This applicant will be free to reapply for scholarship support in a subsequent school year. If the Verification Report/Data Collection Form states that there are conditions (not yet fulfilled) for acceptance into the school and/or program, other than standard contingencies that apply to all admitted applicants, the applicant will not be eligible for consideration for an award for the 2015-2016 school year. All contingencies or conditions, other than standard contingencies, for acceptance must be met and reported to the Scholarship Committee, in writing, no later than April 17, 2015. The Verification Report/Data Collection Form also collects tuition and fees data for the applicant s initial school of record for each school year of the applicant s public health program. The data is to be completed by the academic institution. However, the applicant has the sole responsibility of ensuring that the worksheet is submitted and provided as part of the application. Authorization to Release Information The Authorization to Release Information is required in order for the Scholarship Committee to obtain information about the applicant s school enrollment from his/her public health school program. Evidence of Academic Achievement (Including rank in class if available) Evidence of Academic Achievement is an important factor; therefore an official transcript from the applicant s school of the most recent academic record and current GPA is required. The institution should indicate the grading system for student performance. Resume The applicant should include a summary of experience and skills relevant to future career plans, along with details of extracurricular, volunteer, and leadership experiences. Page 4 of 6

Recommendation Letters The applicant should include two (2) official Recommendation Letters; one (1) from an educator and one (1) from employer or someone familiar with applicant s involvement in community activities. These letters should be presented to applicant in a sealed and un-tampered envelope. The envelope shall remain unopened until it reaches the Scholarship Committee. Application Form The applicant must submit one (1) original copy of the entire completed application packet. ALL information to be considered by the Scholarship Committee (i.e., Application Form, sealed Recommendation Forms, Student Aid Report (SAR) or financial need statement, typed essay, resume, official transcripts from school, etc.) must be enclosed in the application packet submission. Promotions and Press Releases Upon selection, all scholarship recipients must submit a current, professional, color photograph to the Scholarship Committee, which will be used for publicity purposes. Updates and Follow-Up The recipient shall submit a letter report to the Scholarship Committee within six months of receipt of the scholarship describing how the scholarship monies were utilized and how the award aided in furthering their education. If selected, an Update and Follow-Up Template and instructions will be included in the awards announcement. SUBMITTING THE APPLICATION AND PROGRAM INQUIRIES In order to be eligible for the award, all applications and supporting documents must be postmarked or received, if hand delivered, by April 17, 2015. No extensions on the deadline will be granted. Submit all required documents to: Texas Health Resources Community Health Improvement Department Attn: 612 E. Lamar Blvd., Ste. 1400 Arlington, TX 76011 For questions contact: RoschandaFletcher@TexasHealth.org Page 5 of 6

FREQUENTLY ASKED QUESTIONS What is the selection process? The Scholarship Committee will evaluate applications and make the final selections based on: 1. Financial need; 2. Academic/professional achievements; and 3. Personal profile/essay content. Are scholarships taxable? Scholarship funds used exclusively for the payment of tuition and textbooks are normally not taxable. The scholarship recipient is responsible for taxes, if any, that may be assessed against the scholarship award. Consulting a tax advisor for more guidance is recommended. What are my responsibilities as a recipient? After receiving the announcement of the award, the recipient must contact the Scholarship Committee by the deadline date (June 22, 2015) with Notification of Acceptance. The Texas Health Foundation will then deliver the scholarship check to the proper office at the respective institution. The recipient must also begin classes no later than September 25, 2015, maintain full-time status, and provide the Scholarship Committee with updates and follow-ups within six months of receipt of the scholarship. Recipients are expected to complete the educational program and engage the Scholarship Committee in open and direct communication during this time. It is our hope that the recipient will be enthusiastic about becoming a member of the Gerry C. Gunnin Ph.D. Public Health Memorial Scholarship family and want to build a helpful and lasting relationship. What are the requirements for receiving funding from the Gunnin Scholarship? 1. Enrollment in an accredited school of public health in the State of Texas. 2. Enrollment as a full-time student in a graduate or doctoral public health program with a GPA of 3.5 or greater on a 4.0 scale. 3. Must have proof of submission for Student Aid Report or completed financial need statement. Page 6 of 6

Application Form M A I L Mail this form to: Texas Health Resources Community Health Improvement Department Attn: 612 E. Lamar Blvd., Suite 1400 Arlington, TX 76011 TYPE OR PRINT CLEARLY IN BLACK INK 1. PERSONAL INFORMATION Last Name First Name Current Address City/State/Zip Country Home Phone Cell Phone E-mail Address D.O.B. Social Security Number Male Female 2. EDUCATION / EMPLOYMENT HISTORY Current College or University Address City/State/Zip Country School Phone Major / Minor Year Anticipated Graduation Date GPA Application Form Page 1 of 3

APPLICATION FORM (Cont.) List courses taken and anticipated course work with emphasis on public health. Be sure to include titles of all currently enrolled courses. (This can be completed on a separate sheet if necessary). Prior employment, community activities, and educational background including college/university/major/graduation date (Attach resume for additional information): 3. SPECIAL ACHIEVEMENTS / HONORS / RECOGNITION (Use separate sheet for additional activities.) 4. OTHER FINANCIAL ASSISTANCE (List current & projected scholarships/financial aid by source and amount. (Use separate sheet for additional information.) Year Source Amount 5. Include an individual statement of 750 words or less describing personal goals, career plans related to degree in pursuit, leadership roles, work experience and community involvement. This statement should be no longer than two typewritten pages, double-spaced. 6. Attach two Recommendation Letters; one (1) from an educator and one (1) from employer or someone familiar with the applicant s involvement in community activities. 7. Submit an official transcript from the school of the applicant s recent academic record and current GPA. (The transcript should be from your current level of studies. The institution should describe the grading system for student performance.) Application Form Page 2 of 3

APPLICATION FORM (Cont.) I have read the (the Scholarship ) guidelines and understand that if I am selected as recipient: I will be a full-time student at the named university for the period stated in this application; I will ensure the funds received from the Scholarship are only applied toward collegiate expenses, including tuition and fees, books, room and board; I will submit a letter report to the Scholarship Committee by January 29, 2016, describing how the scholarship monies were utilized and how the award aided my education; Upon acceptance of the Scholarship, I will immediately submit a current color photograph of myself to the Scholarship Committee; I authorize the committee to use my name and photograph for publicity purposes. Signature Date APPLICATION DEADLINE: Must be postmarked by April 17, 2015. No extensions on the deadline will be granted. There will be no exceptions. FORM MAY BE PHOTOCOPIED. Mail or Deliver your Application (no faxes please) to: Texas Health Resources Community Health Improvement Department Attention: 612 E. Lamar Blvd., Ste. 1400 Arlington, TX 76011 Application Form Page 3 of 3

Verification of Acceptance/Good Standing Report Data Collection Worksheet for Tuition and Fees (For School Use Only) (The worksheet should be presented to applicant in a sealed and un-tampered envelope. The envelope shall remain unopened until it reaches the selection committee.) This Verification of Acceptance/Good Standing Report certifies that the student identified below has been accepted for admission in the school of public health and is enrolled in good standing for the 2015-2016 school years as indicated. 1. Name of Student: 2. Student s Social Security Number: 3. Program in which student is accepted/enrolled: Masters Doctoral Other 4. Length of Full-Time Program (Years Only): 5. Is the student considered Full-Time in the program? Yes No 6. Number of hours enrolled: 7. Check year in which the student will be/is enrolled in the program for the 2014-2015 Fall term: 1st 2nd 3rd 4th Other 8. Enter the month and year the applicant first entered or will enter the program for which funding is being requested. Month Year 9. Date classes start for the Fall Term for 2015-2016 school year: mm/yyyy 10. Date student is expected to graduate: mm/yyyy 11. Is there a contingency to student s acceptance? Yes No If YES, please explain: (All contingencies must be met by the start of the Fall 2015-2016 term) Verification of Acceptance/Good Standing Report/Data Collection/ Worksheet for Tuition and Fees Page 1 of 3

Data Collection Worksheet for Tuition and Fees 12. NAME OF SCHOOL: 13. ADDRESS: CITY: STATE: ZIP: 14. SCHOOL S EMPLOYER IDENTIFICATION NUMBER: (Also known as Federal tax ID) 15. CONTACT INFORMATION FOR SCHOOL OFFICIAL COMPLETING THIS FORM: NAME: TITLE: PHONE NUMBER: FAX NUMBER: E-MAIL ADDRESS: 16. Check the public health program for which the data is submitted (check only one): Masters Doctoral Other 17. Is summer school an academic term normally required for all students in the public health program? Yes No INSTRUCTIONS: Please provide the cost of tuition and fees for school year 2015-2016 for each year of the public health program regardless of the number of years the student requires to complete the program. Provide the resident (in-state) and non-resident (out-of-state) tuition cost that students will be charged. The tuition amount should reflect the total amount required for school year 2015-2016 for the specified public health program. Scholarship will be paid directly to the school, on behalf of the scholar. Therefore, it is essential that you only enter the total amount for eligible fees that all students in the same program and class year incur regardless of the source of funding. Verification of Acceptance/Good Standing Report/Data Collection/ Worksheet for Tuition and Fees Page 2 of 3

Tuition and Required Fees For School Year 2015-2016 Student in 1 st Student in 2 nd Student in 3 rd Student in 4 th Year of Program Year of Program Year of Program Year of Program Resident Tuition Non-Resident Tuition All Fees Certification: I certify that the information provided on this Verification of Acceptance/Good Standing Report and the Data Collection Worksheet for Tuition and Fees is accurate and complete to the best of my knowledge and belief. I understand that any willfully false statements made herein may be investigated and may be punishable as a felony under U.S. Code, Title 18, Section 1001. Signature of School Official Date THIS REPORT MUST HAVE THE SCHOOL S RAISED SEAL OR STAMP ON IT TO BE ACCEPTED. MAIL TO: Texas Health Resources Community Health Improvement Department Attn: 612 E. Lamar Blvd., Ste. 1400 Arlington, TX 76011 If you have questions, please contact: RoschandaFletcher@TexasHealth.org NOTE: If the supporting information is not postmarked by the April 17, 2015 due date or, there are discrepancies between the information on the application and the Verification of Acceptance/Good Standing Report, the application will be deemed ineligible and will not be considered for the Gerry C. Gunnin, Ph.D. Public Health Memorial Scholarship award. Verification of Acceptance/Good Standing Report/Data Collection/ Worksheet for Tuition and Fees Page 3 of 3

Checklist for Completing the Application The application and documents must be received by the Gunnin Scholarship Committee or postmarked by April 17, 2015. Check each box as documents are assembled to ensure that the application packet is complete. 1. Scholarship Application Guidelines Read the guidelines to ensure compliance with requirements and qualifications. 2. Application Form - Be sure that the application is complete and signed. 3. Personal profile statement Compose 750 words or less, essay describing why the applicant should be selected for the scholarship, with emphasis on financial need, personal goals, and community involvement. 4. Verification of Acceptance/Good Standing Report and Data Collection Worksheet Must be completed by school official and include school seal or stamp. If there are contingencies to acceptance noted on the Verification of Acceptance/Good Standing Report, documentation that the contingencies have been met must be provided. 5. Student Aid Report (SAR) Funding preference is given to students of greatest financial need. To evaluate financial need the committee will use the Department of Education s Expected Family Contribution (EFC) determination. To receive an EFC determination, applicants must submit a Free Application for Federal Student Aid (FAFSA) to the Department of Education. See http://www.fafsa.ed.gov In response to the FAFSA, the Department of Education will provide the applicant with a SAR, which will contain the EFC determination. If you are unable to retrieve this report, please attach a statement of financial need completed by a financial aid advisor at the applicant s current school. 6. Authorization to Release Information Letter - Be sure to complete and sign the authorization letter. 7. Transcript Submit an official transcript from the applicant s school of the most recent academic record and current GPA. Transcript must have schools official seal. 8. Resume Submit a summary of experience and details of extracurricular, volunteer, and leadership experiences. 9. Two letters of recommendation (IMPORTANT) One (1) from an educator and one (1) from employer or someone familiar with applicant s involvement in community activities. Letters should be presented to applicant in a sealed and un-tampered envelope. The envelope shall remain unopened until it reaches the Scholarship Committee. Checklist for Completing the Application Page 1 of 1