Fairmont General Hospital Foundation, Inc.

1325 Locust Avenue Fairmont, West Virginia 26554

information about the

c The Scartz Family Scholarship d

Through the generosity of Mayetta and Albert C. Scartz, a scholarship has been established at the Fairmont General Hospital Foundation to assist graduating high school students to continue their education. This scholarship was created to honor deceased members of the Scartz family. Mr. And Mrs. Scartz both graduated from high schools in Marion and Wetzel County and Fairmont State College. They both had long careers as educators and established this fund to help young students continue their academic careers or receive additional technical training in an other area of study beyond high school.

The recipient of this scholarship is generally announced at the annual Senior Recognition Assembly at their respective high school. The scholarship check is awarded by the FGH Foundation after you take or send proof of registration (i.e., course registration or class schedule) from a college, university, trade school or other technical training program to the Executive Office at Fairmont General Hospital. To be considered for the scholarship, you must have good character and determination. Including a letter of reference would be helpful. Please complete this form and return it promptly. It must be received by the FGH Foundation no later than May 1^st.

Name: ___________________________________ Phone: __________________

Address: ___________________________________

___________________________________ GPA: __________

High School: (include address and phone number of ) ____________________________________________________________________________________________

Please provide a general statement of why this scholarship would help you achieve your goals for a college education and career (you may include information as to your financial need if you so choose):

Please provide a general statement of some of your activities, accomplishments or other information (you may attach no more than a one page resume highlighting your school career to this application):

I verify that the information in this application is true: __________________________ ____________

Student Date

__________________________ ____________

Parent or guardian Date

I recommend this student for consideration: __________________________ ____________

R:Foundation: Scartz Scholarship application Principal or counselor signature Date