Undergraduate Students of NURSING Residing in Allegheny, Washington and Westmoreland Counties. Deborah L. Turner, Scholarship Coordinator

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1 TO: FROM SUBJECT: Undergraduate Students of NURSING Residing in Allegheny, Washington and Westmoreland Counties Deborah L. Turner, Scholarship Coordinator Mary Agnes Powers Scholarship Fund and Southwestern PA Registered Nurse Club Scholarship Funds This letter is to advise you of the application deadline for scholarships for undergraduate students of NURSING residing in Allegheny, Washington and Westmoreland Counties. In order to apply for the scholarship a student must: 1. Be a permanent resident of Allegheny, Washington or Westmoreland County. 2. Be enrolled in a Nursing Program* 3. Maintain good grades 4. Demonstrate financial need 5. Submit a copy of your Student Aid Report (SAR) 6. Complete an application form 7. Submit an official copy of your most recent transcripts *Funding is for the final year of the student s nursing program (school year ). Final selection of the scholarship winners will be decided under the auspices of an Advisory Committee of the Southwestern PA Registered Nurse Club subject to the approval of the Board of Directors of The Pittsburgh Foundation. An application form is enclosed with this correspondence. Completed applications must be returned by March 31st to: Mary Agnes Powers Scholarship Fund Attn: Deborah L. Turner Scholarship Coordinator The Pittsburgh Foundation Five PPG Place, Suite 250 Pittsburgh, PA The Pittsburgh Foundation shall notify the chosen recipients. Scholarship payment will be made after the June Board meeting. The selected student must notify the Foundation of the school she/he is attending for Nursing education.

2 MARY AGNES POWERS SCHOLARSHIP FUND AND SOUTHWESTERN PA REGISTERED NURSE CLUB SCHOLARSHIPS FOR NURSING STUDENTS APPLICATION FORM (Please type or print your response) Date: 1) Name of Applicant: 2) Home Address:_ 1. _ 2. _ 3) County of Residence: 4) School District of Applicant: 5) Telephone: ( ) 6) Student ID#: 7) Date of Birth:

3 Page Two 8) How did you learn about the Scholarship Fund? 9) Please check one of the following and fill in the appropriate information: a) I am pursuing my first Academic Degree/Diploma which leads to a Professional Licensure as a Registered Nurse. b) I am already Licensed as a Registered Nurse and I am pursuing an Advanced Degree in Nursing. School Name: School Address: School Phone: ( ) Date of entry into the Program: Anticipated Date of Completion (Month/Year): Cumulative Grade Point Average: School Attendance: Full-time Part-time 10) Marital Status: Married Single Spouses Occupation: Please list dependents and ages: 11) Please state if you expect to receive financial assistance or scholarships, including, but not limited to, PELL Grant, Stafford or Perkins Loan, SEOG Loan, PA State Grant or Loan, FAFSA: Institution Amount 12) Are you receiving financial reimbursement from your employer for completed college classes? Yes No If yes: How much reimbursement is paid to you per class? How much reimbursement is paid to you per year?

4 Page Three 13) Are you currently employed? Yes No If yes: Full-time Part-time Where do you work: Name of Employer: Address: Phone: ( ) What do you do? 14) Please describe prior work experiences: 15) Please describe prior education: 16) Please describe any financial obligations: 17) Please describe your extra-curricular activities, volunteer work or hobbies over the past three years:

5 Page Four 18) Please state any achievements in the past pertaining to Nursing: 19) Please briefly state your career goals: 20) Have you filed the Free Application for Federal Student Aid (FAFSA)? Yes No I hereby certify that the information provided in this application is true to the best of my knowledge. (Applicant s Signature) Please return the completed application by March 31 st to: Mary Agnes Powers Scholarship Fund Attn: Deborah L. Turner Scholarship Coordinator The Pittsburgh Foundation Five PPG Place, Suite 250 Pittsburgh, PA Incomplete applications will not be considered

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