Scholarship Application

Name *

First

Middle

Last

Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Permanent Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone

Cell Phone *

Email (personal email) *

Alternate E-Mail Address (college/university email) *

Student ID # *

Current School of Nursing *

School Address *

Address Line 1

Address Line 2

City

State

Zip Code

Type of Degree *

Associate Degree
Baccalaureate

*If Other

Expected Date of Graduation (Month and Year) *

Cumulative G.P.A. *

Application Signature *

Educational/Clinical Resume (not an employment resume) *

Drag & Drop Files, Choose Files to Upload You can upload up to 10 files.

Please see the criteria on the previous page.

Professional letter of reference *

Drag & Drop Files, Choose Files to Upload You can upload up to 10 files.

Please see the criteria on the previous page.

Personal letter of reference *

Drag & Drop Files, Choose Files to Upload You can upload up to 10 files.

Please see the criteria on the previous page.

Community Service Involvement Documentation (on letterhead with signature) *

Drag & Drop Files, Choose Files to Upload You can upload up to 10 files.

Please see the criteria on the previous page.

Essay (1 page, single spaced, 3 paragraphs with cited sources in APA format) *

Drag & Drop Files, Choose Files to Upload You can upload up to 10 files.

Please see the criteria on the previous page.

I am African American