SCHOLARSHIP APPLICATION FORM ACADEMIC YEAR 2014/2015

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1 SCHOLARSHIP APPLICATION FORM ACADEMIC YEAR 2014/2015 Name B No. E- mail Permanent Address: Street Address City, State, Zip County Campus Address: Street Address City, State, Zip County Please check ALL semester(s) for which you are requesting Scholarship: Summer 2014 (B.A.T. Students) Fall 2014 Spring 2015 What is your current GPA? HS College If undergraduate student (B.S.), semester/year: Check all that apply: Traditional (admitted as a Freshman to Binghamton) Traditional Transfer Registered Nurse Baccalaureate Accelerated Track Check one: Full Time Student Part Time Student If graduate student (M.S./Ph.D.), semester/year matriculated in program: No. credits completed: Check one: Full Time Student Part Time Student Additional information to help us match you to a scholarship: What is the name of the High School you graduated from? Race/Ethnicity Are you an immigrant? or a child of immigrants with US citizenship? Are you currently a Registered Nurse? What nursing specialty is of interest to you? Do you have any relatives that are alumni of Wilson Memorial Hospital School of Nursing? Where do you hope to practice nursing after graduation? Are you involved in any community service work? If so, what? 1

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3 List below all types of financial assistance for which you applied or anticipate receiving for the academic year, including employment related tuition assistance. Source Amount Applied/Anticipated Statement of Need for Financial Assistance (Use additional pages if necessary): Statement of Academic and Professional Goals (Use additional pages if necessary): I understand and believe I qualify for the scholarship(s) requested. The information provided is accurate and complete to the best of my knowledge at this time. I will advise the Dean of the Decker School of any changes in my residence or of changes affecting my financial status. (signature) (date) Return completed form to: Office of the Dean Decker School of Nursing Binghamton University P.O. Box 6000 Binghamton, NY The application deadline for returning Fall 2014 students is March 28, Applications received after this deadline may be considered for an award on an individual basis. 3

4 The following scholarships are available to DSON students. Please check the scholarship(s) for which you are applying: Arkell Hall Scholarship - Reserved for Decker School of Nursing graduate and undergraduate students who reside in Montgomery, Fulton, Schoharie and Herkimer Counties and who will practice in these counties. Binghamton General Hospital School of Nursing Scholarship Scholarship for matriculated Decker School of Nursing RN student seeking a baccalaureate degree. Demonstrated academic standing of a 3.0 grade point average or more and proven financial need. First consideration will be given to residents of Broome, Chenango, Delaware, and Tioga Counties in New York and Susquehanna County, Pennsylvania. Students from Chemung, Tompkins, Cortland, and Otsego Counties in New York will be given secondary consideration. (FAFSA required.) Broome County Community Charities Scholarship Scholarship for matriculated full or part-time undergraduate or graduate students. First preference for Broome County residents with a second preference for residents living within a 60-mile radius of Broome County. Demonstrated interest in living and working in the Broome County area; and demonstrated financial need. (FAFSA required.) Charles S. Wilson Memorial Hospital School of Nursing Alumni Association Scholarship Awarded to matriculated full or part-time undergraduate Decker School of Nursing students with financial need. Preference will be given to Wilson Memorial Hospital School of Nursing (WMHSON) alumni or relatives of Wilson alumni. Preference will also be given to residents of New York or Pennsylvania with a 60-mile radius of the University. (FAFSA required.) Decker School of Nursing Alumni Scholarship - Scholarship fund for Decker School of Nursing graduate and undergraduate students based on need and/or merit. (FAFSA required.) Dr. G. Clifford and Florence B. Decker Foundation Scholarships - Reserved for graduate and undergraduate students admitted to and enrolled in the Decker School of Nursing who reside in Broome County or within 60 miles of Broome County. Dyer-Johnston-Dixon Nursing Scholarship Awarded by the Rotary Club of Binghamton. Named in memory of Drs. Frank Dyer and Harry Johnston, and to honor Dr. Wilbur Dixon s active support for nursing in the Binghamton community over many decades. Recipients are outstanding Binghamton High School or Seton Catholic Central High School graduates pursuing careers in nursing. Helene Fuld Health Trust Scholarship Fund Established in 2006 exclusively to provide financial assistance to students enrolled in the baccalaureate degree nursing program. (FAFSA required.) Kathleen Lotito Nursing Scholarship Awarded to a matriculated, full-time, undergraduate Decker School of Nursing student with financial need who demonstrates interest in serving in underserved areas of nursing. (FAFSA required.) Lee and Yum Foundation Scholarship Fund Graduate of a high school from Broome County or adjacent counties. Demonstrated financial need as determined by the Office of Student Financial Aid and Employment. (FAFSA required.) Lester Casper Nursing Scholarship - Scholarship for nursing students in financial need. Preference for incoming Decker School of Nursing freshmen students with financial need as determined in consultation with the Office of Student Financial Aid and Employment. (FAFSA required.) Mark and Ann O Neil Scholarship Fund Established to benefit financially needy Decker School of Nursing graduate students. Recipients must be matriculated full or part-time master s degree students. Preference is given to students pursuing a specialty in primary care or gerontology who have an interest in serving community-based elder care or rural elder patients. An overall GPA of 3.0 or higher must be maintained. (FAFSA required.) O Connor Nursing Scholarship Awarded to full or part-time matriculated students enrolled in the baccalaureate, master s or doctoral degree nursing programs. First preference given to students from Delaware County with any balance to be used for students from contiguously surrounding counties. (FAFSA required.) Sheila Jeanne Attleson Nursing Scholarship Decker School of Nursing Master s student who demonstrates merit. Preference for part-time student working as a nurse while completing Master s degree. Preference given to geriatrics study. 4

5 UHS (United Health Services) Hospitals Nursing Scholarship - Reserved for graduate and undergraduate area minorities and immigrants and their children who wish to pursue a nursing education at the Decker School of Nursing. The recipient must be a resident of Broome, Chenango, Delaware, Tioga (NY) or Susquehanna (PA) counties. (FAFSA required.) Valentina and R. Gordon Wasson Scholarship Awarded to full or part-time graduate students in the Decker School of Nursing. Based on academic merit and financial need. (FAFSA required.) William H. Lane Incorporated Scholarship - Matriculated Decker School of Nursing full-time undergraduate student (junior and senior) or full or part-time graduate student working towards an advanced nursing degree (Master s, PhD). Based on academic merit and proven financial need. NYS resident with first preference given to those residing in Upstate NY. (FAFSA required.) Rose Klucka Memorial Nursing Scholarship - Established in 2012 by family and friends in memory of Rose Klucka. Awarded to an undergraduate nursing student with demonstrated academic merit. Preference for a recipient with an interest in Pediatrics. * * * * * * * * * * 5

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