January, Dear Scholarship Applicant:

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1 January, 2015 Dear Scholarship Applicant: Welcome to LOHF s Nurse Education Scholarship Program! We are thrilled that you are interested in applying for a scholarship and we look forward to assisting you throughout the application process. Since 2003, the Lancaster Osteopathic Health Foundation has helped to meet the needs of our community for skilled health professionals by providing tuition scholarships for Lancaster County students. Each year scholarships are awarded to deserving students who are beginning their nursing education, as well as students who are looking to advance their nursing careers. The complete scholarship application can be downloaded from our website, Please read the scholarship program guidelines carefully and be sure to submit all of the necessary items that are listed on the application check list. We cannot review your application if required materials are missing. Feel free to call our office at or send us an at [email protected] if you have any questions. We must receive your completed application package by May 29, A selection committee consisting of nurses and LOHF staff will review applications and identify finalists for interviews that will take place at our office in July Award recipients will be notified by mail in July 2015 and invited to attend an awards reception held in September. Initial scholarship payments will be made to the nursing schools in August We are honored to be able to offer this scholarship opportunity to outstanding students who are pursuing a nursing career. We wish you all the best! Sincerely, Anna Brendle Kennedy Executive Director

2 2015 Nursing Education Scholarship Application Due No Later than Friday, May 29, 2015 Name: Address: Home Phone: Cell Number: Address: College Attended, if any: Degree: Date of Birth: High School Attended: Year Graduated or Year GED Obtained: Nursing School Admitted to: Full or Part Time Program: Day or Evening Program: LPN RN RN to BSN BSN MSN OTHER(specify): Program Start Date: Expected Completion Date: Are You Fluent in Other Languages: If so, which languages: Check List of Information to be Included with this Application: Admission Letter from Nursing Education Program (Pre-Nursing Students and General Education Students are NOT eligible) Evidence of Financial Status (copy of FAFSA form, or recent IRS Income Tax Form) Lancaster Osteopathic Health Foundation Financial Worksheet Documentation of any grants, scholarships, loans, and employer tuition reimbursement Letter of Reference Form completed by a teacher, supervisor, etc., and mailed directly to LOHF Copy of Recent Transcript Write two one page essays using two of the following prompts: Describe the unique skills and strengths you will bring to a career in nursing. Why did you decide to choose a career in nursing? What experience(s) encouraged you to want to advance your nursing career? Describe a particular case that has inspired you to pursue this career advancement. Application Signature & Documentation: In signing this application, I hereby authorize the Lancaster Osteopathic Health Foundation (LOHF), if relevant, to seek release of my FAFSA financial form and/or documentation of Pell Grant or other tuition support and information on my academic standing from the nursing education program in which I am enrolled. I understand and accept the obligation to work in nursing in Lancaster County (year for year) for each year of scholarship support I receive from LOHF. I agree that if I am unable to do so or if I withdraw from the program before completion, the remaining portion of the scholarship grant will convert to a loan repayable to the Foundation under terms to be mutually negotiated. I affirm that all information provided is true and accurate. Signature Date

3 2015 Nursing Education Scholarship Program Policy Guidelines Scholarships are available for students accepted and entering or already enrolled in nursing education programs in the academic year 2015/2016. Scholarships are for tuition only. Scholarships are available for LPN and RN nursing education programs at Lancaster County Career & Technology Center, PA College of Health Sciences, HACC-Lancaster Campus, Millersville University, and Eastern Mennonite University (Lancaster). Scholarships are also available for any accredited BSN program, RN to BSN program, master, post master, and doctoral nursing programs, and certification classes, including but not limited to school nurse, lactation consultant, and others requiring additional education. Those students enrolled in Pre-Nursing or General Education classes or programs are NOT eligible. Only students enrolled in RN to BSN, master, post master and doctoral nursing programs are eligible for scholarships for remote learning programs. LPN and RN students must be enrolled in one of the Lancaster County nursing education programs listed above. Scholarships last for the full education period of the program if student remains in the program. Individuals who have already received a nurse scholarship and wish to continue their nursing education are encouraged to re-apply for an additional scholarship. Scholarships are paid directly to academic institution on behalf of the recipients. Requirements Applicants must be permanent residents of Lancaster County at time of application. Applicants must be already admitted to nursing education program at time of award/application. Applicants must provide a FAFSA form or tax return and supply documentation of any Pell Grants, scholarships, employer tuition reimbursement or other tuition awards. Scholarship Work Obligation Policy By accepting a nurse scholarship from LOHF, the scholarship recipient agrees to work full time in nursing in Lancaster County one year for each year of scholarship support awarded; if this condition is not met, the scholarship recipients are required to pay back their scholarship awards to LOHF according to specific payment terms. Written application may be made for an exception from this policy. Such exceptions require approval of the LOHF s Nurse Scholarship Committee. Withdrawal Policy Scholarship recipients who leave school after receiving a nurse scholarship from the Foundation will be required to pay back their scholarship awards to the LOHF. Written application may be made for an exception from this policy. Such exceptions require approval of the LOHF Board of Directors. Leave of Absence Policy If the scholarship recipient is granted a leave of absence, LOHF will allow the unspent balance of funds to remain in the student s account for up to two years from the date of the leave approval. The recipient must return to the nursing education program within two years.

4 Lancaster Osteopathic Health Foundation 2015 Nurse Scholarship Financial Worksheet Candidate Name: Tuition Costs: Amount of Yearly Tuition Amount of Other Grants, Scholarships Amount of Employer Reimbursement Tuition Balance Annual Gross Income: Self-Income Self-Alimony, Child Support, Government Aid Spouse Income Parents Income (if you are claimed as a dependent) Total Please list any family members living with you and/or additional dependent children who depend on you for financial support. (Please include age and relationship to you.) Please list all grants and scholarships that you will receive and their dollar amount.

5 2015 Nursing Education Scholarship Letter of Reference Form Scholarship Applicant s Name Name of Reference Employer and Title Telephone Number In what professional capacity do you know the applicant and for how long? What do you consider to be the applicant s strengths/weaknesses? What is your assessment of applicant s interest in and ability to succeed in a nursing career? Name of Reference Date Please return this form before May 29, 2015 to: Lancaster Osteopathic Health Foundation 128 East Grant Street, Suite 104 Lancaster, PA Ph. (717) Fax (717) [email protected]