Ochiltree General Hospital Auxiliary Scholarship

The Ochiltree County Hospital Auxiliary Scholarship is given annually by the Ochiltree County Hospital Auxiliary to graduates of Perryton High School. The scholarship is in the amount of $1,000. Applicants are not restricted to any areas of study. Deadline for this scholarship is April 1. ♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥♥ The Ochiltree County Hospital Auxiliary/Brian Smith Memorial Scholarship is given annually by the Ochiltree General Hospital Auxiliary to graduates of Perryton High School. This scholarship is in the amount of $1,000. This scholarship is dedicated in memory of Brian Smith, (son of Dr. Tripps and Becky Childers. Brian was a member of the Perryton High School student body and was killed in an automobile accident in September of 1999. The applicant must major in a medical related field. Deadline for this scholarship is April 1.

Ochiltree General Hospital Auxiliary Scholarship

Last First Middle Street or Box No. City State Zip Father’s Name Occupation Mother’s Name Occupation

Name:

Address:

Date of Birth:

Marital Status: (check one) _____Married _____Single _____Other

Do you have children? _____Yes _____No If yes, how many?

Are you employed? _____Yes _____No If so, where?

Parents/Guardians:

Phone:

Number of Dependent Children in Family: Ages of dependent children:

College/University you will attend: Major:

Will you have any brothers/sisters attending college at the same time that you are attending? If so, how many?

Number in graduating class:

Overall GPA:

Class Rank:

Extra-curricular activities, honors, awards, and special recognition received in high school. Names and addresses of three people in the community to be used as character references. Name Address Phone Name Address Phone Name Address Phone

1.

2.

3.

How do you plan to pay for your education? List other scholarships and their amounts that you have already received. Please write a description of why you have chosen a particular field of study. If applying for the Brian Smith Memorial Scholarship, please write a description of why you are going into the medical field.

% Parents and/or relatives __________ % Personal income or savings __________ % Scholarships __________ % Grants __________ % Loans __________