THE UNIVERSITY OF TEXAS AT ARLINGTON COLLEGE OF NURSING

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1 THE UNIVERSITY OF TEXAS AT ARLINGTON COLLEGE OF NURSING and HEALTH INNOVATION SCHOLARSHIP APPLICATION This application may be used for nursing scholarships and recommendations for outside scholarships. Undergraduate and Graduate (MSN, Doctoral) students may apply when meeting the following criteria. Undergraduate students who apply must have been admitted to the junior level of nursing courses. Undergraduate nursing students who have completed at least one semester (13 hours) are eligible for College of Nursing and Health Innovation scholarship funds. Undergraduate nursing students are encouraged to apply for scholarships during the Junior I, Junior II, and Senior I semesters in the BSN program, and during the junior semester of the RN to BSN program. Graduate nursing students who have completed 12 hours, are eligible for College of Nursing and Health Innovation scholarship funds. Graduate nursing students are encouraged to apply for scholarship during the semester which they will be completing 12 hours (semester two or three of the graduate program). Scholarships will be awarded for the next semester, following application for scholarship. be eligible for available nursing scholarships, a completed nursing scholarship application form must be submitted to the Office of Enrollment and Student Services on or before the scholarship deadline. Deadlines, available nursing scholarships are located in the Office of Enrollment and Student Services, Room 647. Applications may be hand delivered to Pickard Hall room 647, ed to jackymack@uta.edu or mailed to the below address. UT Arlington College of Nursing Attn: Office of Enrollment and Student Services Scholarships 411 S. Nedderman Dr. Box Arlington, TX Application requirements: Applications must be typed or computerized; computerized applications must follow the application format. Applications that are not typed or computerized will not be considered. Applications may be accessed on the College of Nursing website: Awards are based on the following criteria, in order of priority: 1. Academic performance (Minimum 3.25 cumulative GPA for undergraduate students and 3.5 cumulative GPA for graduate students). A student with less than the stated GPAs will not be considered. 2. Leadership (community service, professional organization activities, etc.) 3. Financial need. Both fulltime and part-time CONHI students are eligible for scholarships. Part-time students must be taking a minimum of five graduate hours or six undergraduate hours in order to apply for a scholarship. Part-time students who receive scholarships receive awards proportionate to the number of credit hours earned. Some scholarships are awarded directly through the College of Nursing and Health Innovation and may be renewable each semester the recipient is enrolled. Renewable scholarships will be renewed automatically if the student maintains the minimum required GPA (graduate 3.5 and undergraduate 3.0) and the funds are available. Some scholarships may require a higher GPA. Students are not required to request the renewal. Students who are not residents of the state of Texas may pay resident tuition rates for the registration period for which the scholarship is awarded if the following components are met: The award must be at least $1,000 for the academic year The award must be competitive; competition must be with other students and must include Texas residents The award must be granted by an official UT Arlington Scholarship Committee Internal scholarships awarded by the College of Nursing and Health Innovation meet the components listed above.

Undergraduate students who apply must have been admitted to the junior level of nursing courses.

2 THE UNIVERSITY OF TEXAS AT ARLINGTON COLLEGE OF NURSING and HEALTH INNOVATION SCHOLARSHIP APPLICATON FORM Section I: Student Information Name: _ Last, First, Middle UT Arlington ID Number: Address: Street Address, City, State, Zip Code Contact Info: Home/Cell Phone Work Phone _ Address Residence Status: (Check all that apply) Classified as a US citizen Classified as out-of-state resident by UTA Permanent Resident (your Visa status allows you, as a non US citizen, to reside indefinitely in the US) Citizen of a country other than the US Pre-licensure BSN Students Only: Are you an active member of the Honors College? RN to BSN and Graduate Students Only: If you are an RN, have you had or do you currently have a stipulation against your license? Is your license encumbered? Do you have a BSN? If yes, did you graduate from UT Arlington? If yes, did you graduate from the RN to BSN Program? All Students Relationship Question for Scholarship Applications State law requires that each student identify any relation to a current member of The University of Texas System Board of Regents. A student who is related to a current member of the U.T. System Board of Regents is prohibited from receiving scholarships unless the scholarship is awarded exclusively based on academic merit or is an athletic scholarship. It is a Class B misdemeanor to file a false statement. Are you related to any member of the U.T. System Board of Regents? If yes, please identify the Board member and the relationship.

by UTA Permanent Resident (your Visa status allows you, as a non US citizen, to reside indefinitely in the US) Citizen of a country other than the US Pre-licensure BSN Students Only: Are you an

3 Applicable relationships include one of the following: 1. Regent s spouse, spouse s child, spouse s parent, child s spouse, parent s spouse; 2. Regent s spouse s brother or sister, spouse s grandparent, spouse s grandchild, brother s or sister s spouse, grandparent s spouse, grandchild s spouse; 3. Regent s parent, daughter, son; 4. Regent s brother, sister, grandparent, grandchild; or 5. Regent s great-grandparent, great-grandchild, uncle or aunt (brother or sister of parent) nephew or niece (son or daughter of brother or sister). A list of the current members of The University of Texas System Board of Regents is available at: Have you ever been on, or are you currently on, disciplinary probation for academic dishonesty? Semester currently enrolled: (Check one) BSN Program: Junior I RN to BSN Program: Junior Semester Graduate Program: MSN Enrollment Status: (Check one) Junior II Senior I Senior semester Doctoral Full-time Senior II Hours Completed Part-time If part-time how many semester hours are you currently enrolled in? How many semester hours have you completed in the College of Nursing? For Office Use: (The College of Nursing will provide GPA). Cumulative GPA: Section II: Educational History entered UTA: Expected graduation date: College(s) or University(ies) attended School Degree

Regent s brother, sister, grandparent, grandchild; or 5.

4 Section III: Employment Are you currently employed? If yes, average number of hours each week Employment History Employer Address Section IV: Scholarship and Financial Aid History Briefly describe your need for financial assistance. Please limit to space in box. Scholarships, loans, grants, etc you have been awarded Source Status Section V: Academic Awards and Honors Semester Awards/Honors

Scholarship and Financial Aid History Briefly describe your need for financial assistance.

5 Section VI: Leadership/Professional and Community Involvement (Include student organizations, limited to last three (3) years) Organization Level of Involvement (Member of committee, officer, etc.) s (to and from) Give a brief statement of the qualification which make you eligible for scholarship. Please limit to space in box. 1. Are you a member of ANSA? Yes No 2. If so, list 2 pre-approved ANSA events you participated in this semester. Section VII: Career Interest and Professional Goals Give a brief statement of your future plans. Please limit to space in box. Indicate your special areas of interest in nursing. For example: oncology, pediatrics, etc. Please limit to space in box. 1. I will be enrolled in the UTA College of Nursing and Health Innovation while participating under this scholarship program. Should I leave the CONHI nursing program, I agree to repay the scholarship. 2. I will use the proceeds of the scholarship for payment of tuition, required fees, professional equipment, materials, and books. 3. I hereby acknowledge that the information submitted herewith is true and correct. I hereby release from liability all representatives and agents of The University of Texas at Arlington College of Nursing and Health Innovation for their acts performed in good faith and without malice in connection with evaluating this application, credentials and qualifications, and hereby release from any liability any and all individuals and organizations who provide information to this institution s representative, in good faith and without malice, and I hereby consent to the release of such information. _ Signature of Applicant

If so, list 2 pre-approved ANSA events you participated in this semester. Section VII: Career Interest and Professional Goals Give a brief statement of your future plans. Please limit to space in box.

Undergraduate Admissions. One UTSA Circle JPL 1.01.04 San Antonio, Texas 78249

Undergraduate Admissions. One UTSA Circle JPL 1.01.04 San Antonio, Texas 78249 Undergraduate Admissions The University of Texas at San Antonio One UTSA Circle JPL 1.01.04 San Antonio, Texas 78249 P: 210.458.8000 futureroadrunner@utsa.edu utsa.edu/admissions/transfer The University