NURSING SCHOLARSHIPS COVER SHEET

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1 NURSING SCHOLARSHIPS COVER SHEET (Please attach cover sheet to the front of your CHP Departmental Scholarship/Fellowship Application indicating which scholarship(s) you want to be considered for) 1 TO APPLY: 1. Read criteria on pages 4-6 for individual scholarships carefully. On the list below, check the scholarships for which you are eligible and for which you wish to be considered. 2. Complete the College of Health Professions scholarship application form (pages 2-3). Directions for completing application are on page 2. Complete the financial aid section if you wish to be considered for scholarships that have financial need as criteria for selecting the recipient(s). Also, the FAFSA, federal financial aid form, should be on file in the WSU Office of Financial Aid by April 1, The CHP Departmental Scholarship/Fellowship Application is required to apply for both College of Health Professions general scholarships AND for specific endowed nursing scholarships. 3. A reference letter(s) is required for ALL nursing scholarships and must be included to be considered for a scholarship(s). Individual scholarship criteria indicate who should provide the letter(s). Letters can accompany application or can be mailed to the Nursing Department directly from the individual writing the letter. See page 2 for additional requirements regarding goal statement and activities chart (#4 and #5). 4. Return completed materials to Undergraduate Nursing Office, Room 541 Ahlberg Hall, WSU School of Nursing, Wichita, KS by March 1, Detach here. Please staple to the front of your CHP departmental scholarship application and materials NURSING SCHOLARSHIPS for Name Student ID Number Please circle which program you are admitted into: BSN Accelerated BSN RN to BSN Masters DNP Please consider me for the following scholarship(s): (requirements for scholarships on pages 5-7) For Undergraduates: Alley, Gladys H. Scholarship in Nursing Bolton, Orville and Margaret Brookhouser, Vicky S. Scholarship Fitzpatrick, Hermina Endowed Scholarship Halstead, Helen Scholarship Henderson Scholarship Huntington, Patricia J. McNamara Johnson Scholarship Lantz, Mildred L. Scholarship in Nursing Piper, Ola Osborn Scholarship Riordan, Dr. Janice-Endowed Scholarship Sanchez-Gietzen Scholarship Shideler, Charles & Betty-Scholarship Via Christi Endowed Scholarship Webb, J Eleanor Endowed Scholarship Wesley Foundation Nursing Scholarship Whittaker, Regina L. Behring Endowed Letter(s) of recommendation is being written by: Applicable Only to Students Enrolled in the Accelerated BSN Program: Anderson, Bob & Darlene Accelerated Nursing Scholarship For Graduate and Undergraduates: Kruger, Dr. Susan Scholarship/Fellowship Miles, Gene & Marie Endowed Scholarship/Fellowship Rose, Paul Christopher & John Timothy Scholarship/Fellowship Sterling, George E. & Blanche Scholarship Wesley Women s Assoc. Maternal-Child Nursing Scholarship/Fellowship Zona Richardson Scholarship/Fellowship Graduate Nursing Fellowships: Anderson, Robert & Darlene Fellowship Rose, Ray Memorial Endowed Nursing Fellowship

2 2 Students Admitted and Continuing in Professional Programs College of Health Professions Departmental Scholarship/Fellowship Application Application Instructions: 1. FOR ALL SCHOLARSHIPS/FELLOWSHIPS, you must be admitted to a College of Health Professions professional program AND have a minimum cumulative GPA of 3.0. An interview may be requested as part of the selection process. 2. Complete the financial aid information section of the application if you wish to be considered for needbased scholarships/fellowships and file a Free Application for Federal Student Aid (FAFSA). 3. Attach a TYPED one page personal statement limited to 500 words. You may use your statement to highlight your special interests, talents, goals or unique experiences. Please include long range goals. The personal statement allows you to provide additional information for consideration by the scholarship/fellowship committee. 4. Attach an activities chart including your academic, leadership, extracurricular, campus, community service, and work experiences. With each activity, provide the dates you were involved, time commitments and any leadership roles you had. (Please see example of chart). 5. Return this application to your departmental office in Ahlberg Hall. Keep a copy of this application for your records. This application is for awards from Dental Hygiene, Health Science, Health Service Management and Community Development, Medical Technology, Nursing, Physical Therapy, and Physician Assistant. 6. Application deadline is March 1, 2014 for Nursing. STUDENT DATA Legal Name Last First Middle Maiden or other WSU ID: Date of birth (mm/dd/yyyy): _ Mailing Address Apartment # City State Zip Phone ( ) Cell Phone ( ) WSU Address: _ Alternate Address: Academic Major: Anticipated Graduation (semester/year): Expected enrollment (# of credit hours) at WSU during: Fall 2014 Spring 2015 Are you a U.S. citizen or Permanent Resident? Yes No Are you currently employed? Yes No Hours per week CRITERIA QUESTIONS: The following questions are used to determine your eligibility for specific scholarships/fellowships. (This is not a full list of CHP scholarships/fellowships nor are these the only criteria used to determine the awards.) Sherr Scholarship/Fellowship (circle your classification): undergraduate graduate Campuzano Scholarship: Are you a first or second generation immigrant to the USA with permanent residency or US citizenship? Yes No

3 3 Benn Memorial Scholarship/Fellowship only: Are you a Derby High School graduate? Yes No O Blenness Scholarship/Fellowship: Gender: Female Male FINANCIAL AID INFORMATION (optional): All financial information will be kept confidential. This section is optional but must be completed along with the FAFSA if you wish to be considered for need-based scholarships. STUDENT: PARENT(S) or GUARDIAN(S): (Dependent students only) Estimated yearly gross income Estimated yearly gross income Total number of dependents (not including yourself, spouse/partner) Total number of dependents (not including yourself, spouse/partner) Number of dependents who will be full-time college students in AY Number of dependents who will be full-time college students in AY Yes No Has there been a significant change in your financial status in the past year? If yes, please include a Financial Statement with your application. Instructions below. Yes No Has there been a significant change in your financial status in the past year? If yes, please include a Financial Statement with your application. Instructions below. FINANCIAL STATEMENT: If you feel the financial information entered above and on your FAFSA does not fully reflect your current economic situation, please complete a financial statement and include it with your application. You may include information regarding you and your family s financial status that supports your need for scholarships. Student Certification and Signature: I certify all answers I have given in this application are accurate to the best of my knowledge. I understand failing to disclose or falsifying information could result in my dismissal from Wichita State University and making a false writing is a felony under Kansas law (K.S.A ). Social security number and student status data may be provided to other state agencies for use in fraudulent or illegal claims against state monies. I grant permission to obtain information about my grade point average, enrollment status, and financial status to evaluate my candidacy for scholarship awards. I understand this information will be kept confidential and will be available only to the scholarship committee having a need to know for the purpose of scholarship determination. If I am awarded a scholarship, I authorize the University to publish my name as a scholarship recipient. If offered an award, you will be expected to attend the College of Health Professions' annual scholarship/fellowship reception for the opportunity to thank your donors in person. You are also expected to send a thank you letter to your donor. Signature of Applicant Date Notice of Nondiscrimination: Wichita State University does not discriminate in its programs and activities on the basis of race, religion, color, national origin, gender, marital status, sexual orientation, age, status as a Vietnam-era veteran or disability. Any person having inquiries concerning this may contact the Office of Equal Employment Opportunity, Wichita State University, 1845 Fairmount, Wichita, KS , (316)

4 4 This is the recommended format for an activities chart: Scholarship Requirements - School of Nursing Alley, Gladys H. Scholarship in Nursing. Student must be enrolled full-time in the Nursing Program. No recipient will be excluded from consideration based on race, religion, color, national origin, gender, age, sexual orientation, marital status, status as a veteran or disability. Recipients must maintain a 3.4 grade point average. Award will be made without regard to financial need. The Scholarship maybe renewed based upon satisfactory academic progress. Bolton, Orville and Margaret. Full or part time. Minimum GPA of 3.0. Renewed annually for maximum of 2 years with satisfactory performance. Financial need not required. Bob & Darlene Andersen Accelerated Scholarship. Student must be enrolled full-time in the Accelerated Nursing Program. Award will be made without regard to financial need. The Scholarship may be renewed based on satisfactory academic progress. Brookhouser, Vicky S. Scholarship. Enrolled full or part time in the CHP School of Nursing. Consideration given to a non-traditional female nursing student with children. Minimum GPA of 3.0. Financial need considered. A 1-2 page biography to be reviewed by Ms. Koehn or her designee outlining: what motivated the applicant to return to school and what can be identified as a special life circumstance which motivates the student for this scholarship. Renewed automatically with satisfactory performance. Fitzpatrick, Hermina End. Scholarship. Full or part time enrollment in the nursing program. Minimum GPA to meet School of Nursing criteria. Financial need not a consideration. Dr. Helen Halstead Nursing Scholarship. Criteria for the scholarship include a minimum GPA of 3.00, full-time enrollment in the nursing program and a written essay concerning experience and/or commitment to working with the aging population and in gerontological nursing settings. Henderson Scholarship. One scholarship is awarded annually to a full time nursing student with a 3.0 or above GPA who demonstrates leadership qualities. Awards will be made with regard to financial need and will be renewed automatically so long as the student maintains satisfactory progress in the nursing program. Hesse, J. Francis Scholarship. Must be enrolled full time in the WSU nursing program.

5 Financial need required. Not renewed automatically. Huntington, Patricia J. McNamara-Memorial Endowed Scholarship. Full or part time entering the first year of the undergraduate program at WSU. Financial need must be documented in the FAFSA. Submit a 750 word essay to be reviewed outlining: why the student wishes to pursue nursing and what are their aspirations in serving as a nurse. Must maintain a 3.0 GPA. May be renewed for 2 years or until graduation. J. Eleanor Webb Endowed Scholarship in Nursing. Scholarship will be awarded annually to an undergraduate student(s) enrolled full or part-time in WSU Nursing. Award(s) will be made without regards to financial need. The scholarship(s) may be renewed based upon satisfactory academic progress. Johnson Scholarship. Awards will be made with regard to financial need and will be renewed automatically "so long as the student maintains satisfactory progress and in the judgment of the nursing scholarship committee, maintains a positive attitude." Dr. Susan Kruger, School of Nursing Scholarship. A BSN or MSN student who has earned a 3.5 or above GPA in 12 or more nursing credit hours and who demonstrates leadership qualities can apply. Two letters of reference are required. The scholarship is renewable. Lanz, Mildred L., Scholarship in Nursing. One scholarship will be awarded annually to a student enrolled full-time in the Nursing Program. Preference given to a Kansas resident. Recipient must have and maintain a 3.0 GPA. Award will be made with regard to financial need. The scholarship will be renewed as long as the recipient meets the required criteria, but no longer than four semesters. Miles, Gene & Marie End. Scholarship. Full or part time student. Minimum GPA in accordance to SON criteria. Financial need demonstrated through the FAFSA. Letter of reference from college instructor/professor. Ola Osborn Piper Scholarship. Several scholarships are available for WSU junior or senior nursing students each year. The primary criterion for scholarship award is demonstration of financial need. A letter of reference from a faculty member is also required. Riordan, Dr. Janice-Endowed Scholarship. Full or part time student. Maintain a GPA of 3.0. Demonstrate financial need through the FAFSA. May be renewed automatically with satisfactory performance. Rose, Paul C & John T Memorial Scholarship. Must be currently employed by Wesley Medical Center in prenatal or neonatal special care units. Intent to concentrate career in prenatal and/or neonatal care. Letter of recommendation from head of WMC prenatal unit. Minimum GPA of 2.5. Short paragraph of current activities and future plans to donor facility. Rose, Ray Memorial Endowed Nursing Scholar. Must be a graduate student in the MSN. GPA must be at least a 3.0 or above. Awards are made with no regard to financial need. The fellowship may be renewable. Sanchez-Gietzen Scholarship. Scholarship is awarded to a student who is enrolled full or part time in the BSN program. Academic merit and financial need is considered. One letter of reference is required. Automatic renewal with satisfactory performance. Shideler, Charles & Betty Scholarship. Full time enrollment in the BSN program. Minimum GPA of 3.0. Demonstrated leadership qualities. One letter of reference. May be renewed with satisfactory performance. Letter of intent confirming plans to remain in Kansas for 1 year after 5

6 graduation. Sterling, George E. & Blanche Scholarship. Scholarship will be awarded annually to a student(s) enrolled full or part time at Wichita State University in the School of Nursing. No recipient will be excluded from consideration based on race, religion, color, national origin, gender, age, sexual orientation, marital status, or disability. Award(s) will be made without regard to financial need. Via Christi Endowed Scholarship in Nursing. Scholarship(s) will be awarded annually to an undergraduate student(s) enrolled full-time at WSU in the School of Nursing. No recipient will be excluded from consideration based on race, religion, color, national origin, gender age, sexual orientation, marital status, status as a Vietnam Era Veteran or disability. Preference will be given to Kansas residents. Recipient(s) must have and maintain a minimum of a 3.30 grade point average. Awards(s) will be made without regard to financial need. Zona Richardson Scholarships are available for students in all WSU nursing programs: undergraduate, RN to BSN, RN to MSN and graduate. Scholarships can be renewed for a second year. Criteria include GPA of 3.20, specified hours of enrollment, USA citizen or permanent resident and reference letter from instructor or health care agency employer (supervisor). Awards are made without regard to financial need. Preference will be given to students from Southwest Kansas. Wesley Women's Association Nursing Scholarship. One endowed scholarship is awarded annually to a baccalaureate nursing student who has an outstanding academic record and demonstrates leadership qualities. The scholarship is renewed automatically so long as satisfactory academic progress is maintained. The recipient is asked to sign a letter of intent that he/she will remain in the State of Kansas for at least one year after graduating from Wichita State University. Wesley Women s Association Maternal/Child Nursing Scholarship. One endowed scholarship is awarded annually to a graduate nursing student with an interest in maternal/child nursing. A cumulative GPA of 3.25 or above, demonstrated leadership qualities and enrollment in a minimum of six hours are required. An interview may be scheduled as part of the selection process. The recipient is asked to sign a letter of intent that he/she will remain in the State of Kansas for at least one year after graduating from Wichita State University. Whittaker, Regina L. Behring Endowed. Must be a citizen of the USA and enrolled full-time. Awards will be made with regard to financial need. 6

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