Berks County Community Foundation-Thomas T. Wheatley Memorial Scholarship Fund Application

The Thomas T. Wheatley Memorial Scholarship Fund

This scholarship was established at Berks County Community Foundation in 2006; but was initially established at Exeter Ambulance Association in 2004, following the death of Thomas Wheatley. Tom made his mark on many lives by the countless contributions he made to the community. As a teenager he became an Eagle Scout in the Boy Scouts and after college was a scoutmaster for several years. He made a difference in the community by becoming an EMT and then a paramedic. Tom was a paramedic for over 22 years and was head paramedic for the Upper Perkiomen Valley Ambulance Association. Tom was an active member for over 18 years, vice president, and board member of the Exeter Ambulance Association. He was a believer in education and founder of the Exeter Ambulance Community Training Center. He was regional facilitator and affiliate faculty member of the American Heart Association. Tom passed away on February 12, 2004. In his honor the training center was renamed the Thomas T. Wheatley Community Training Center, and the memorial fund was established.

The fund will provide annual scholarships to benefit one or more Berks County residents to pursue an education in one of the following medical fields: EMT, Paramedics, Phlebotomy or Nursing. Applicants must be at least 16 years of age, and adults may also apply. Current or recently graduated high school or college students must have maintained a cumulative GPA of 3.0 or above in high school or college to apply for this scholarship. All applicants must submit an essay of no more than one page as to “Why you want to pursue an education in the EMT, Paramedics, Phlebotomy or Nursing field and why you are choosing this field as a career.” Applicants must have volunteered for at least 100 hours in the field in which they are selecting to further their education or in any other medical field.

To be considered for this scholarship, please fill out the form below and submit electronically by April 1:
In addition to submitting the form below electronically by April 1, you must mail in the following attachments postmarked no later than April 1. Put your name on all submissions:

If you are currently in high school or college or have graduated from high school or college within the last four years, attach your most recent high school or college transcript. If you have graduated from high school or college more than four years ago, no transcript is necessary to be submitted.
A letter or statement from someone who can attest to your volunteer hours you refer to in the application.

Applicant Name:

Prefix	First	MI	Last	Suffix

Street Address:

Address 2 (optional):

City:

State: Zip Code:

Home Phone Number:

Email address:

Age:

County of Residence:

Education

High School you are currently attending or graduated from:

Current grade/year if you are still in high school:
High School Graduation Date:

Are you currently in college?
yes
no

Did you graduate from college?
yes
no

If yes, what was your college graduation date?

If you graduated from college or are currently attending college, list the name of the college you are attending (attended) and the degree you are (did) pursue?

Click one of the following medical fields in which you will pursue an education and are looking for for financial assistance from this scholarship fund:
EMT
Paramedics
Phlebotomy
Nursing

What is the name of the educational institution/program where you intend to pursue this education?

Where is the educational institution located?

What is the cost to pursue this education at the institution/program noted above?

What is the length of training required?:

Employment
Current employer (if applicable):

Are you currently employed?
yes
no

If yes, please name your employer and the position you hold:

How long have you been employed at the employer you listed?:

Awards/Scholarships

Have you received or do you anticipate receiving any scholarships, grants, awards, etc. for the upcoming academic year? If so, please indicate which ones and the amount of each (do not include loans):

Volunteerism
Please explain the volunteer activities you've participated in related to the field of study you are selecting or any medical field, and the number of hours of volunteer service:

Community Service
Please explain any community service activities you participated in in the past two yearsand any leadership roles you displayed in those activities:

Please attach a one-page essay that describes why you want to pursue an education in the EMT, paramedics, phlebotomy or nursing field and why you are choosing this field as a career.

How did you hear about the Community Foundation?

Note: Berks County Community Foundation employees, board members and/or committee members are not eligible to apply or be nominated for a grant or scholarship, nor are their immediate family members. Immediate families include spouses, children, stepchildren, grandchildren, and stepgrandchildren. The ineligibility period for Berks County Community Foundation board members or employees extends five years after board service or employment terminates. The ineligibility period for committee members who are not Berks County Community Foundation board members or employees is in effect only during their term of service.