TENNESSEE
ASSOCIATION OF BLOOD BANKS
SCHOLARSHIP APPLICATION
(See intructions
for completion below)
SCHOLARSHIP GUIDELINES
1. Applicants must be a U.S. citizen or
a permanent resident of the United States.
2. Applicants must be accepted into or are in an approved Specialist in
Blood Banking (SBB)
or Medical Technologist (MT) program.
3. Applicants cannot complete their education before the scholarship is
awarded.
Name ________________________________________________
Home Phone _________________
Business Address ___________________________________________________________________
Work or School Phone Number________________________________________________________
School Name ______________________________________________________________________
Dean/Administrator/CEO/Program Coordinator
of School___________________________________
School Address ____________________________________________________________________
School Phone Number ____________________
E-Mail address (Optional)_____________________
Select the type of program you will be attending
below:
Full Time __________Part Time __________
Online/Distant Learning ______________
Anticipated Graduation or Completion Date
_____________________________________
Certification or Degree Sought _______________
Length of Program ______________
I. EDUCATION/TRAINING (Send an official
transcript from each College/University)
College/University Dates attended Major Degree
II. CERTIFICATION(S)
III. PROFESSIONAL ACTIVITIES RELATED TO
SBB, MT, AND/OR CLS.
Professional Activity DatesOffices Held
IV. HONORS AND CITATIONS (explain significance
and include date awarded):
V. PROFESSIONAL ORGANIZATION MEMBERSHIP
Are you a TABB Member?
Circle one: Yes No
Year joined TABB ________________
Other Scientific Societies Membership #Dates belongedOffices
Held
VI. VOLUNTEER OR WORK EXPERIENCE: (List most recent first)
Employer Position/job description Dates of Employment
VII. ANTICIPATED EXPENSES RELATED
TO COURSE WORK
Tuition and Fees
$ _________
Books
$__________
Other (specify)
$ _________
$ _________
Total
$_________
VIII. OTHER SOURCES OF SUPPORT
(List Amount Expected)
Scholarship(s) Names
__________________
$_________
Loans
$__________
Full or
Part-time Work $__________
Parents/Others
$ _________
Total
$__________
IX. OBJECTIVES: Attach a brief statement
(500 words or less) describing your interest and reasons for pursuing
a degree in Medical Technology, or a Certificate as a Specialist in Blood
Banking.
X. REFERENCES/LETTER OF ADMISSION:
Please submit the following:
A Letter of Admission (LOA) or acceptance
to the applicant’s program,
2 Letters of Recommendation (LOR),
Copy of College Transcript(s).
NOTE: The applicant is responsible for ensuring
that all required documents have been sent. A completed application consists
of: the original application, letter of admission, two letters of recommendation,
your transcripts, and statement of objectives. We will not ask for missing
documents and only complete application packets will be reviewed. Attach
additional pages if you need more space to complete the information.
Print out this form, complete the required information,
and send form and required attachments to: