The Crouthamel Family Nursing Scholarship Fund Established in 2006

Transcription

1 1234 Market Street Suite 1800 Philadelphia, PA p f The Crouthamel Family Nursing Scholarship Fund Established in 2006 Gertrude Burmeister Crouthamel Trudie Crouthamel Eadline Miriam Crouthamel Karsner Lois Crouthamel Sweeten Gertrude Burmeister Crouthamel ( ) was a Registered Nurse who trained at The German Hospital (later named The Lankenau School of Nursing) in Philadelphia. Following her early career in private duty nursing, Gertrude and her husband, Edgar, a Lutheran minister, had seven children. Three of Gertrude s daughters also trained at Lankenau as Registered Nurses. All of the Crouthamel nurses took great pride in their vocations, and genuinely enjoyed serving others. To honor his mother and this family s remarkable heritage of nursing, Mark Karsner endowed this scholarship fund at The Philadelphia Foundation for children, grandchildren and siblings of nurses who wish to study nursing in the Philadelphia area. Along with financial need and excellence in school, the most important criterion for applicants is a heartfelt desire to help people with their medical needs. The Philadelphia Foundation, a community foundation, was established in 1918 and serves the southeastern Pennsylvania region. It is comprised of over 800 individually named charitable funds. For more information, please visit our website at

2 1234 Market Street Suite 1800 Philadelphia, PA p f CROUTHAMEL FAMILY NURSING SCHOLARSHIP SCHOLARSHIP APPLICATION APPLICATION DEADLINE: May 15, 2015 The creation of this scholarship was inspired by relatives of the Crouthamel family who were registered Nurses (RNs) and who took great pride in their profession and genuinely serving others. For the academic year, one scholarship of $500 for tuition assistance will be awarded to an individual entering or studying in an Associate Degree nursing program, a nursing diploma program or a BSN program. ELIGIBILITY preference be given to the child, grandchild, niece, nephew or sibling of a nurse have a genuine desire to help others must have unmet financial need graduating high school seniors or individuals returning to school to study nursing applicants must have good grades in their high school or post-high school studies CHECKLIST Completed all questions on the application form Attached a high school transcript Attached a post-secondary transcript (if applicable) Attached a copy of your school s estimated costs and your financial aid award. Attached a financial aid award letter from college if available Attached your statement of ASPIRATIONS AND GOALS Attached a letter of support from your sponsor (if applicable) Submitted a Recommendation Form to your reference Signed and dated the application form By May 15, 2015, mail or deliver your completed application with attachments to: The Philadelphia Foundation Crouthamel Family Nursing Scholarship 1234 Market Street, Suite 1800 Philadelphia, PA Inquiries can be directed to Miranda Porter, Scholarship Associate at or mporter@philafound.org.

3 CROUTHAMEL FAMILY NURSING SCHOLARSHIP SCHOLARSHIP APPLICATION APPLICATION DEADLINE: May 15, 2015 Please print or type. Application is five pages long. APPLICANT INFORMATION Name _ Last First Middle Permanent Address Street City County State Zip Telephone ( ) Date of birth FAMILY INFORMATION Please check relationship. Father/ Stepfather/ Guardian Address Mother/ Stepmother/ Guardian Address Check if applicable: father deceased mother deceased parents separated parents divorced Number of siblings financially dependent on parent(s)/guardian OR Name of spouse Address

4 HIGH SCHOOL INFORMATION Please attach a copy of your transcript. High school attended Year of graduation Experience Attach a separate listing or your resume. Please list extracurricular activities, jobs, internships, and volunteer experience in which you have participated during the past four years. Include clinical and practical experiences, and student organizations. POST SECONDARY EDUCATION INFORMATION If you are currently in a program, please provide a copy of your transcript. Program you plan to attend or are currently attending. Institution Address Will you be a full-time student Yes No When do you anticipate completing your program? POST SECONDARY EDUCATION FINANCIAL AID INFORMATION Have you received or been promised other financial aid (scholarships, loans, grants, etc.)? Yes No If you have answered YES above, please provide the following information regarding other financial assistance. You may attach a separate page if necessary. Amount Date Received Term Purpose FINANCIAL INFORMATION -- PERSONAL Financial need is one of the criteria for scholarship selection. Please attach a copy of your school s estimated cost of attendance. Please attach a copy your Financial Aid Award.

5 ASPIRATIONS AND GOALS Please submit a statement on an attached sheet describing your personal aspirations and educational and career goals. This statement should be 1-2 typewritten, double-spaced pages and must include information that will answer each of the following questions: Why are you pursuing a career in nursing? In what area of nursing do you plan to specialize? Optional Please attach an additional sheet of paper with any additional information or factors which you believe should be considered by the Advisory Committee in reviewing your application. SPONSOR Are you related to nurse(s) who trained at Lankenau Hospital School of Nursing? Yes No OR Are you being proposed for this scholarship by relative, teacher or friend who trained to be a nurse at Lankenau Hospital School of Nursing? Yes No NOTE: If possible, please enclose a letter of support from your sponsor. Sponsor's name at graduation: Year of graduation Relationship Sponsor s current name Sponsor s current address _ Sponsor s current telephone ( ) CERTIFICATION I hereby affirm that the information provided on this form is accurate and complete to the best of my knowledge. I give to The Philadelphia Foundation permission to use my name and photograph in any print or electronic media. Signature Date By May 15, 2015, mail or deliver your completed application with attachments to: The Philadelphia Foundation Crouthamel Family Nursing Scholarship 1234 Market Street, Suite 1800 Philadelphia, PA 19107

6 1234 Market Street Suite 1800 Philadelphia, PA p f CROUTHAMEL FAMILY NURSING SCHOLARSHIP SCHOLARSHIP RECOMMENDATION FORM Recommendation due to The Philadelphia Foundation by May 15, 2015 Applicant's Name Date Print Applicant's Signature NOTE: Signature grants permission to send information Check in the appropriate column your estimate of each trait listed: Consistently Moderately Seldom 1. In a work situation is the applicant: a. Resourceful b. Orderly c. Accurate d. Dependable e. Punctual f. Cooperative g. Thorough h. Adaptable i. Energetic 2. Is the applicant: a. Sensitive to the reactions of others b. Trustworthy c. Tolerant d. Tactful e. Well poised f. Self-controlled g. Receptive to criticism

7 Applicant's Name How long have you known the applicant? a. What do you consider the applicant's chief qualities? Strengths: Weaknesses: b. Does the applicant work well with people? Explain. c. Do you place full confidence in this applicant's integrity? Explain. d. Would you like this person to take care of you if you were ill? Explain. 4. Would you endorse this applicant to receive a scholarship from The Crouthamel Family Nursing Scholarship Fund? Yes No If your answer is "no," please comment. Thank you for your help. Name Print Signature Position Address Telephone ( ) Date Please return this form by May 15, 2015 directly to: The Philadelphia Foundation Crouthamel Family Nursing Scholarship 1234 Market Street, Suite 1800 Philadelphia, PA Please contact Miranda Porter at (215) if you have any questions.