Scholarship Application - Central New York Area Health Education Center, Inc.

Step 1 of 3

L. Thomas Wolff Scholarship Application
Please remember to send your transcripts. They can be emailed to info@cnyahec.org or mailed to: CNYAHEC, 1970 West Fayette Street Syracuse, NY 13204

Three letters of references must accompany the application for the candidate to be considered.

Please request that your school send CNYAHEC an official transcript of your grades to date.

This application must be typed or neatly written. Only complete applications (including all attachments) will be considered.
Selection Criteria

Academic Achievement Community Engagement Career Plan Character Summary Statement

10% 15% 35% 30% 10%
I hereby attest that I have read and understand the application instructions and meet all criteria for eligibility for the L. Thomas Wolff Scholarship, to the best of my knowledge.*
- I agree

Academic Achievement	Community Engagement	Career Plan	Character	Summary Statement
10%	15%	35%	30%	10%

Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
County*
Date of Birth*
MM slash DD slash YYYY
Phone (Home)
Phone (Cell)
Email*
College/Training Program Attending
Expected Graduation Date
Field of Study
Degree
How did you learn about the L. Thomas Wolff Scholarship?

I. Academic Achievement
Please ensure that your official transcripts have been sent directly to CNYAHEC.
Date Transcript Requested:
MM slash DD slash YYYY
List all school activities in which you have participated in the past four years (e.g. student government, music, sports).
Activity # of Years Special Awards, Honors, Offices Held
II. Community Engagement
List all community activities in which you have participated without pay during the past four years (e.g. volunteer work, youth club, church work, volunteer work). Note special awards, honors, and offices held.
Activity # of Years Special Awards, Honors, Offices Held
III. Career Plan
1. Describe any paid work experience or activities with which you have participated in the past four years that would serve to support your future career.
Experience Date Begun Date Ended Hrs/Week Type of Work (Experiences)
2. Describe your specific career plan, beginning with the training you are about to enter.
School/Work Beginning Year End Year Planned Outcome (e.g. B.S., R.N., Prep for next position, etc.)
3. Identify if you would like to practice (work) in the area, and if so, for how long. If you are planning on working in the area, please explain why you wish to do so. If not, please explain why you wish to leave the area.
IV. Character
Make sure to have three personal and/or professional letters of references submitted with this application.
Describe your personal characteristics. Explain how and why those characteristics fit well with, and support, your career objectives.
Upload Reference Letters:
Drop files here or

Max. file size: 50 MB.
V. Summary Statement
Please provide any other information about yourself, your intentions, or your life circumstances that you think are important in the consideration of your candidacy for the L. Thomas Wolff Scholarship.

Step 1 of 3

L. Thomas Wolff Scholarship Application

Selection Criteria

I. Academic Achievement

II. Community Engagement

III. Career Plan

IV. Character

V. Summary Statement

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Experience	Date Begun	Date Ended	Hrs/Week	Type of Work (Experiences)

School/Work	Beginning Year	End Year	Planned Outcome (e.g. B.S., R.N., Prep for next position, etc.)

Activity	# of Years	Special Awards, Honors, Offices Held

Activity	# of Years	Special Awards, Honors, Offices Held