Scholarship Application. Do you have questions? Please Hope Ferguson at Application due date: Friday, March 28, 2014

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1 Scholarship Application Do you have questions? Please Hope Ferguson at Application due date: Friday, March 28, 2014 MSNAF Scholarship DEADLINE for scholarship applications is Friday, March 28, 2014 at 5:00 p.m. (NO EXCEPTIONS) 2. Refer to application process below for a list of the supporting documents needed (i.e. recommendations, official transcripts). Incomplete applications will not be considered. 3. If any question does not apply to you in this application please put N/A in the space. 4. Type or print legibly. Illegible applications will be returned to you. 5. You will be notified in May at Ether Ball regarding your selection for a scholarship. 6. If you have any questions about the application, please call Hope Ferguson, Vice President of Memphis Student Nurse Anesthesia Foundation. (601) or by at MISSION STATEMENT The Memphis Student Nurse Anesthetist Foundation promotes the nurse anesthesia profession through scholarship, community service and congregation of anesthesia professionals while offering students the opportunity to broaden their scope of professional engagement. FINANCIAL ASSISTANCE is based on financial need, academic performance, leadership potential, and participation in volunteer programs. Scholarships are awarded annually provided funds are available. SCHOLARSHIP AWARDS The Memphis Student Nurse Anesthetist Foundation awards scholarships on the basis of a comprehensive process. Areas that are reviewed by the committee include, but are not limited to the following: Academic Accomplishments, Community Service, Personal Essay and Financial Need. Memphis Student Nurse Anesthetist Foundation pays scholarship funds directly to the recipient s school. Scholarships are awarded each year. The Memphis Student Nurse Anesthetist Foundation Scholarships are awarded without regard to race, color, ethnicity, gender or sexual orientation. Scholarships awarded are based upon the availability of funds and additional qualifying criteria.

2 CRITERIA Applicants must be in attendance or recently accepted into The University of Tennessee Health Science Center College of Nursing DNP-Nurse Anesthesia Program. Applicants must be accepted as a full time student at The University of Tennessee Health Science Center. If scholarship money is awarded, this is the only university that will receive the funds on behalf of the applicant. Applicants must demonstrate a need for financial assistance based on estimated family contribution (EFC). Applicants must be a citizen or legal permanent resident of the United States. Student must apply for the Federal Student Aid Application (FAFSA). Applicants must complete and submit a Scholarship Application by Friday, March 28, Scholarship recipients will receive their check once recipients have been named. TIMELINE Applications are due March 28, Applicants are notified if awarded a scholarship by May Application Process SCHOLARSHIP APPLICANTS MUST PROVIDE: Completed application form. Proof of acceptance or attendance at the University of Tennessee Health Science Center. Demonstrated financial need via FAFSA application. SCHOLARSHIP AWARDS Award notification will be given by mid-may Applicant must provide their student ID, the correct mailing address of their institution and the department where their scholarship check is to be received. Award amounts will be distributed at the end of May CRITERIA FOR SCHOLARSHIP RECIPIENTS If applicant is awarded a scholarship, twelve volunteer hours per academic year must be completed within the Memphis area. Volunteer hours are counted beginning June 1 st in the summer and ending April 1st the following year. All scholarship recipients will coordinate a plan for how they will meet their service requirement with the Memphis Student Nurse Anesthetist Foundation Public Relations Director after accepting the scholarship.

3 Deadline for the application is Friday, March 28, Applications postmarked after this date will not be considered. Please mail application to: Memphis Student Nurse Anesthetist Foundation Scholarship Program P.O Box Memphis, TN 38163

4 Application 2014-must be filled out by applicant. Please type on a separate sheet or print your answers below. If application is illegible it will be returned to you. 1 Last Name: First Name: 2 Mailing Address:: Street: City: State: ZIP: 3 Daytime Telephone Number: ( ) address: 4 I will be attending the following school in the Fall of 2014: Address/ Phone 5 What year will you enter school? 1 st year 2 nd year 3 rd year Graduate SRNA 6 Will you be a full time student? 7 Will you be a commuting student? If you are not living on campus, where will you be living? 8 List the name of any college you have attended. Year Began Year Ended Year Graduated Type of Degree Received A. B. C.

5 9 What specialty/major do you plan to major in as you continue your education? 10 List expenses you expect to incur per semester or quarter: (Approximate figures acceptable) additional comments if needed. Make A. Tuition: Amount: $ B. Books: Amount: $ C. Room & Board: Amount: $ D. Other expenses: Amount: $ E. Other expenses: Amount: $ 11 List other financial assistance you will receive per semester or quarter: A. Personal: Amount: $ B. Other Scholarship(s): Amount: $ C. Grants: Amount: $ C. Student Loan(s): Amount: $ D. Other Financial Resources: Amount: $ Please list the following information on a separate sheet if needed. 12 SCHOOL EXTRA-CURRICULAR ACTIVITIES: Please list school extra-curricular activities in which you have participated. Note leadership roles and dates. 13 AREA OF STUDY: What do you want to study and why? (Should be between words in length) 14 ORGANIZATIONS: Please list community organizations such as service, volunteer and religious organizations in which you are now active or have previously been active. Note leadership roles and dates.

6 15 RECOGNITIONS: Please list important awards and recognitions received. Note organizations presenting honor and date. 16 GOALS: What are the short and long term goals for your life? 17 NEED: Please explain your need for the Memphis Student Nurse Anesthetist Foundation Scholarship. 18 CAREER PLANS: What are your career plans and what would you like to be doing in 10 years? 19 A. The following items must be attached to this application in order for the application to qualify to be reviewed by the scholarship committee. B. Your application will be returned to you if these items are not attached to this application. (No exceptions.) C. Circle YES or NO to be sure you have attached each item as required. YES NO Proof of college acceptance or current student enrollment. A letter of college acceptance or program acceptance is required for receipt of funds. YES NO Answers to questions 1-18

7 STATEMENT OF ACCURACY I hereby affirm that all the above stated information provided by me to the Memphis Student Nurse Anesthetist Foundation Scholarship Committee is true, correct and without forgery. I also consent that my picture may be taken and used for any purpose deemed necessary to promote the MSNAF Scholarship Program. I hereby understand that if chosen as a scholarship winner, according to the MSNAF scholarship policy, I must provide evidence of enrollment/registration at the post-secondary institution of my choice before scholarship funds can be awarded. Signature of scholarship applicant: Date: Witness Date: The deadline for this application to be received by the Memphis Student Nurse Anesthetist Foundation is Friday, March 28, 2014, 5:00 p.m. No exceptions!

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