I. Criteria:
1.
Applicant must be a resident of
2. Applicant must be enrolled in a National League for Nursing (NLN) or Commission on Collegiate Nursing Education (CCNE) accredited nursing program.
3. Applicant must currently demonstrate a minimum B average in all college level course work.
4. Applicant must demonstrate financial need.
5. Applicant must have successfully completed at least one clinical rotation in nursing, or be a Certified Nursing Assistant or Licensed Practical Nurse.
II.
Instructions/information:
1. Arrange for your college/nursing school to send an official transcript of your grades to the Scholarship Chairperson.
2. Ask three people to write and mail letters of reference to the Scholarship Chairman. (See Section VIII of this application form)
3.
All information must be received no later than
4. Applicants may be invited to a personal interview by the Scholarship Committee in late April or early May after all of the information has been received.
(Confidential
information is for use by the Scholarship Committee use only.)
1. Full Name_______________________________________________________________
2. Home Address__________________________________________________________
3. Email Address____________________________________________________________
4. Home Phone____________________ Cell Phone______________________________
5. Name of nursing program in which I am enrolled________________________________
Type of nursing program: Baccalaureate_____ Associate______ Graduate_______
6. Approximate yearly educational expenses
Tuition_____________ Room and Board______________ Books/Fees_______________
IV. Family Data:
(Please complete this section only if you classify yourself as a traditional student (age 17 - 23 primarily supported by a parent/guardian)
1. Total number of children currently financially supported by your parent/guardian___________
2. Number of children in college currently supported by your parent/guardian___________
3. Ages and grades in school of other children currently supported by your parent/guardian
________________________________________________________________________
_________________________________________________________________________
(Please complete this section only if you classify yourself as an adult student (over age 23 and not primarily supported by a parent /guardian or under age 23 and self supporting)
1. Are you employed?___________ Approximate number of hours per week_____________
2. Employer__________________________________________________________________
3. Do you have dependents?_______ Ages of Dependents_____________________________
___________________________________________________________________________
V. Have you received or will you receive financial aid from other resources?_______________________
If yes please explain________________________________________________________________
__________________________________________________________________________________
VI. Why do you need a scholarship?_________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
VIII How did you learn about this scholarship opportunity? ____________________________________________________________________________
________________________________________________________________________________________________________________________________
IX. References:
List the names, addresses and occupations of 3 people you have asked to provide letters of reference to the Scholarship Committee. Include at least one nursing instructor who has knowledge of your school performance. If you are now, or have ever been employed, include one of your employers. Submit the required letters along with your application.
**** Nursing students
who have previously applied for this scholarship and are reapplying need to
provide
only one new letter of reference***
1. Name_________________________________________Occupation_________________________
Address_____________________________________________________________________
2. Name_________________________________________Occupation_________________________
Address_____________________________________________________________________
3. Name_________________________________________Occupation_________________________
Address_____________________________________________________________________
Date of application________________________
Signature of applicant__________________________________________________________________
Mail application and
reference letters to:
Mrs. Dale Ford Call
(847) 253-1312 with questions
Scholarship
Chairperson AHNC
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