PACIFIC GROVE HYPERBARIC CHAMBERDR. TAK HATTORI MEMORIAL SCHOLARSHIP

The Pacific Grove Hyperbaric Chamber is proud to announce the 2017 Dr. Tak Hattori Memorial Scholarship. This scholarship honors Dr. Tak Hattori who served as the Medical Director for the Pacific Grove Hyperbaric Chamber for 44 years. Dr. Hattori was one of the driving forces behind the acquisition and installation of the hyperbaric chamber. During his tenure as Medical Director he volunteered thousands of hours, ensuring that the all-vol-unteer staff had the most current training in hyperbaric medicine and that the absolute best medical care was offered to those suffering from diving related injuries and carbon monoxide poisoning. His influence extended beyond the hyperbaric chamber as he worked closely with local hospitals’ emergency departments and physicians educating them in the identification, diagnosis and initial treatment of diving-related and carbon monoxide poi-soning medical issues. Dr. Hattori’s volunteer service to the Pacific Grove Hyperbaric Chamber was in addition to serving as a radiologist at Community Hospital of Monterey Peninsula. He also volunteered with the Japanese American Citizen League, Monterey Planning Commission and served on the Board of Directors for the Asilomar Conference Center. His service was recognized by the U.S. Coast Guard, the Undersea & Hyperbaric Medical Society, Monterey County, the City of Pacific Grove and the U.S. Congress.

2017 Application Instructions and Requirements

• The applicant must be in their senior year of high school and a resident of Monterey, Santa Cruz or San Benito County.

• The applicant must plan to attend an Accredited Institution of Higher Education.• High school transcripts must be submitted with the application and the applicant

must have a high school cumulative GPA of 3.0 or above.• Two (2) letters of recommendation must be submitted with the application packet.

Each letter of recommendation must be placed in a sealed envelope and signed across the seal by the writer of the letter.

• The application package must be mailed to the address below. Hand-delivered or electronic applications will NOT be accepted. Applications must be postmarked by April 1, 2017. Mail your completed application package to:

Pacific Grove Hyperbaric Chamber

Dr. Hattori Memorial Scholarship

600 Pine Ave

Pacific Grove, CA 9350

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2017 Scholarship Selection Criteria and Awards

The following criteria will be used to select the 2017 Pacific Grove Hyperbaric Chamber Dr. Hattori Memorial Scholarship recipient:

• Academic accomplishments• Community involvement and extra-curricular activities• Achievements, honors and recognitions• Essay and letters of recommendation

The scholarship award is $1500. Scholarship recipients have until October 1, 2017 to pro-vide proof of enrollment on official school letterhead. Scholarship funds will be disbursed directly to the recipient to apply toward tuition, room and board, books and other fees.

By signing below, I am verifying that the information I have provided in this application is accurate and consistent with my education and actual experience. I freely consent to allow the Scholarship Committee to confirm all the information included in this application. If se-lected as a scholarship recipient, I agree to allow use of my name and picture on the City of Pacific Grove’s website, Pacific Grove Hyperbaric Chamber website and Pacific Grove Hy-perbaric Chamber’s Facebook page.

Signature of Applicant Date

Signature of Parent Date

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PACIFIC GROVE HYPERBARIC CHAMBER

2017 DR. TAK HATTORI MEMORIAL SCHOLARSHIP APPLICATION

NAME: ________________________________________________________________________

ADDRESS: _____________________________________________________________________

__________________________________________________________________________________

PHONE: _________________________

EMAIL ADDRESS: ________________________________________________________________

List all high schools, colleges or technical schools attended, starting with the most recent:

School Name City, State Dates Attended

List any high school sponsored sports and clubs in which you participated, include any of-fices held.

List any honors, awards or recognitions you received during high school.

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List all community involvement/activities you participated in during high school.

List any employment or work experience, including type of work and time of service.

What college or university do you plan to attend?

What course of study will you pursue?

What profession/career do you plan to pursue after you complete your course work?

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ESSAYNote: Essay must be typed, double-spaced using 12-point font and not exceed one page. 1. Dr. Hattori displayed selfless service both to the community, and within his profession

through his volunteer service. How do you plan on serving your community with your chosen course of study?

LETTERS OF RECOMMENDATION

Provide two (2) letters of recommendation, one from a teacher/school counselor that can discuss your academic capacity and one from a personal reference. Each letter of recom-mendation must be placed in a sealed envelope, signed across the seal by the writer of the letter.

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