2015 ONF-SMITH EDUCATION SCHOLARSHIP Approved by the ONF Board March 17, 2014

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1 2015 ONF-SMITH EDUCATION SCHOLARSHIP Approved by the ONF Board March 17, 2014 The Oregon Nurses Foundation (ONF)-Smith Education Scholarship was established through the contribution of Milton F. Smith of Roseburg, Oregon. The endowment fund is administered by the Oregon Nurses Foundation in collaborative partnership with the Oregon Nurses Association (ONA) Cabinet on Education. In 2015, scholarships will be given in the amount of $1,000 to individuals enrolled in an undergraduate or graduate nursing program. ONA staff members are not eligible for scholarship consideration. Criteria for the Scholarships: 1. Active enrollment in an accredited baccalaureate or graduate nursing program in the State of Oregon. The program must be accredited by a national nursing accreditation organization recognized by the United States Department of Education. 2. A cumulative Grade Point Average (GPA) in nursing of 3.25 or greater for undergraduate applicants and 3.5 or greater for graduate applicants. 3. The critical elements of the application review are: a. Commitment to nursing practice in Oregon (include timeline) (35%) b. Leadership abilities and experiences (30%) c. Experiences with other cultures, minority groups, and underserved populations (30%) d. Explanation of need for ONF-Smith Education Scholarship funds (5%) 4. The applicant who is not yet a registered nurse must be a member of the Oregon affiliate of the National Student Nurses Association. The registered nurse applicant must be an ONA member in good standing. 5. A pledge to join ONA or a constituent member association of American Nurses Association upon registered nurse licensure. 6. All documents related to the application are due at Oregon Nurses Foundation, SW Boones Ferry Road, Suite 200, Tualatin, Oregon 97062, postmarked no later than Monday, June 1, Recipient obligations. The awards will be announced annually in the Summer of each year. In addition, each recipient must provide written acknowledgement of the award to ONF and provide responses about how the funds were used in the year following receipt of the award. 8. The financial award will be made available in the same year. The scholarship will be applied to educational costs and will be sent directly to the Registrar. FOR OFFICE USE ONLY DATE RECEIVED DOCUMENTS MUST BE RECEIVED BY POSTMARK DEADLINE OF June 1, 2015 Application Letter of acceptance to nursing program Official transcripts with all college coursework Certified statement of cumulative GPA at 3.25 or greater for undergraduate; 3.5 or greater for graduate Three (3) letters of recommendation sent directly to ONF by the individuals providing references 1

In 2015, scholarships will be given in the amount of $1,000 to individuals enrolled in an undergraduate or graduate nursing program. ONA staff members are not eligible for scholarship consideration.

2 OREGON NURSES FOUNDATION SW Boones Ferry Road, Suite 200 Tualatin, OR (503) ONF-SMITH EDUCATION SCHOLARSHIP APPLICATION (YOU WILL BE NOTIFIED IF ADDITIONAL FORMS ARE REQUIRED) ALL DOCUMENTS MUST BE TYPED Applicant's Name Telephone Last First Middle Street/PO Box City State Zip Have you been accepted into a nursing program? Yes No (Attach letter of acceptance) School Program: Generic Baccalaureate Program RN to Baccalaureate Program Graduate Program (specify) Evidence of membership in or affiliate of: NSNA or ONA NSNA or ONA Membership # Expiration Date EDUCATION AND TRAINING Institutions Name and of School Graduated Yes No Degree Received Areas of Specialization High School College Graduate School of Nursing Special Training /Military Training NOTE: Please have the college send a statement of cumulative GPA certified by the Registrar s office. They must also send Official Transcripts for all college coursework directly to ONF. 2

Yes No (Attach letter of acceptance) School Program: Generic Baccalaureate Program RN to Baccalaureate Program Graduate Program (specify) Evidence of membership in or affiliate of: NSNA or ONA NSNA

3 ALL DOCUMENTS MUST BE TYPED Employment Information Employer Name and (Most recent employer first) Dates Employed Job Title and Description of Duties Company Mo. Yr. Telephone Number Supervisor Mo. Yr. Company Mo. Yr. Telephone Number Supervisor Mo. Yr. Company Mo. Yr. Telephone Number Supervisor Mo. Yr. Company Mo. Yr. Telephone Number Supervisor Mo. Yr. Company Mo. Yr. Telephone Number Supervisor Mo. Yr. (If additional space is needed, attach a separate sheet) 3

4 Pledge to Join Nursing association I, pledge to become a member (print name) of Oregon Nurses Association if I am practicing in Oregon (or a constituent member association of American Nurses Association if I am practicing outside of Oregon) at the time I am licensed as a registered nurse. Signature Date Witness This form must be printed and signed in front of a witness and must be sent with the application materials. 4

practicing outside of Oregon) at the time I am licensed as a registered nurse.

5 ALL DOCUMENTS MUST BE TYPED 1. Commitment to nursing practice in Oregon (include timeline). (35%) What do you envision you will be doing in nursing in 5 years? In 10 years? Instruction and clarification: We want to know how you plan to contribute to the nursing and health care needs of Oregonians as well as where you think you will be practicing. 2. Provide a description of honors, awards, and leadership positions you have held. (30%) What you should describe is: Examples of honors, awards and leadership may include experiences prior to entry to the nursing program as well as in the nursing program. Examples of leadership positions should make clear whether these were paid, elected or appointed, the length of time, and the contribution to the organization which resulted from the leadership. 5

Provide a description of honors, awards, and leadership positions you have held.

6 ALL DOCUMENTS MUST BE TYPED 3. Provide a description of your experiences with other cultures, minorities, and underserved populations. (30%) What you should describe is: Structured learning opportunities in another culture Service (paid, volunteer) to an underserved population Mastery of another language that facilitates work with or understanding of another culture (not English) 4. Explanation of need for ONF-Smith Education Scholarship funds. (5%) What is the reason you are seeking these scholarship funds? Instruction and clarification: We want to understand, beyond the obvious, what part of your nursing education these monies will support. 6

language that facilitates work with or understanding of another culture (not English) 4. Explanation of need for ONF-Smith Education Scholarship funds.

7 ALL DOCUMENTS MUST BE TYPED 5. Names of persons to whom you have given reference forms. Obtain at least one reference from a nursing faculty member known in the last five years or a current supervisor. References from a personal friend are not accepted. (1) Name/Position Telephone/ (2) Name/Position Telephone/ (3) Name/Position Telephone/ This completes the applicant responsibility portion of the packet. View the instructions on pages 8 10 to complete the remaining application requirements. submit form by submit by postal mail or fax: Nursing program letter of acceptance must be attached with submission. Oregon Nurses Foundation SW Boones Ferry Rd, Ste 200 Tualatin, OR Fax:

(1) Name/Position Telephone/Email (2) Name/Position Telephone/Email (3) Name/Position Telephone/Email This completes the applicant responsibility portion of the packet.

8 CERTIFIED STATEMENT OF CUMULATIVE GPA & ALL COLLEGE LEVEL COURSEWORK APPLICANT: This page must be printed and provided to your Registrar s office in order to obtain official SEAL from Registrar. It cannot be filled out online. This certifies that the cumulative GPA for at is. Official college-level coursework transcript is attached / being sent separately. Seal Registrar (please print) Registrar's signature REGISTRAR OFFICER: Please mail this form directly to: OREGON NURSES FOUNDATION SW Boones Ferry Rd, Suite 200 Tualatin, OR Must be postmarked by JUNE 1,

Official college-level coursework transcript is attached / being sent separately.

9 Applicant's Name 2015 ONF-SMITH EDUCATION SCHOLARSHIP APPLICATION REFERENCE FORM APPLICANT: Please provide a copy of this form (either by printing or electronically) to each of your three (3) references to complete. This reference form must be postmarked by JUNE 1, 2015 The above named applicant is applying for the ONF-Smith Education Scholarship. In addition to the applicant's GPA, we ask each applicant to supply personal references. Your cooperation in completing the questions below would be very valuable to us in considering the applicant for the ONF-Smith Education Scholarship. All references are confidential and are not shared with the applicant by the ONA Cabinet on Education. I. Knowledge of the Applicant 1. How long have you known the applicant? Yr(s) Mo(s) 2. In what capacity have you known the applicant? II. Relative ratings of the applicant: Please use your knowledge of the applicant to rate the characteristics listed below. In rating the applicant, please keep in mind the comparison group you state below (undergraduate students, graduate students, practicing nurses, or other). Comparison group: Specific Characteristics (Please Check) N/A Unable to Judge (0) Minimal Evidence (1) Adequate Evidence (2) Substantial Evidence (3) 1. Strength of interest/commitment of nursing 2. Motivation/diligence 3. Ability to get along with others 4. Professional integrity 5. Clinical competence 6. Demonstration of leadership skills 7. Ability to organize 8. Critical thinking/analytic abilities 9. Communication skills/ability to articulate ideas 10. Creativity FOR OFFICE USE ONLY TOTAL POINTS REFERENCE FORM Page 1 of 2 9

In addition to the applicant's GPA, we ask each applicant to supply personal references.

10 III. Comments: (Please consider the characteristics rated in Section II) IV. Are you willing to further discuss the applicant's qualifications? Yes No Name Title or Position Daytime phone Evening phone Signature Please mail this form directly to: OREGON NURSES FOUNDATION SW Boones Ferry Rd, Suite 200 Tualatin, OR Must be postmarked by JUNE 1, 2015 REFERENCE FORM Page 2 of 2 10

Yes No Name Title or Position Daytime phone Evening phone Signature Please mail this form

2015 CENTENNIAL EDUCATION SCHOLARSHIP

2015 CENTENNIAL EDUCATION SCHOLARSHIP Description of Fund: The Centennial Education Scholarship Fund was created by the Oregon Nurses Foundation (ONF) in 2003. During 2003 and 2004, ONF members were successful