LAMAR UNIVERSITY JOANNE GAY DISHMAN DEPARTMENT OF NURSING MAMIE MCFADDIN WARD HEALTH CAREERS SCHOLARSHIP APPLICATION INSTRUCTIONS

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1 Deadline ELIGIBILITY: LAMAR UNIVERSITY JOANNE GAY DISHMAN DEPARTMENT OF NURSING MAMIE MCFADDIN WARD HEALTH CAREERS SCHOLARSHIP APPLICATION INSTRUCTIONS For Administrative Use Only Required Documents SAR Report Notary Full-time students who have been admitted to any of the following programs in the College of Arts and Sciences: Master of Science in Nursing Bachelor of Science in Nursing SELECTION CRITERIA: A. Scholastic potential and achievement as indicated by Scholastic Aptitude Test scores, collegiate grade point average, and assessment by the appropriate program director. B. Need for financial assistance as demonstrated by a completed financial statement indicating how assistance will enhance the applicant s opportunity to achieve career goals. C. Must have a Financial Aid Supplement and Free Application for Federal Student Aid (FAFSA) on file in the Financial Aid Office. APPLICATION PROCEDURE: A. Complete all application forms; sign Certification and Release form; and have all appropriate signatures notarized. B. Submit a copy of the Student Aid Report (SAR) with the application. C. Submit all application materials to: Nursing Information Center JoAnne Gay Dishman Department of Nursing Room 255 McFaddin Ward Building Awards are issued on an academic-year or semester basis. There may be summer awards. Renewal awards are available to students who maintain eligibility. Applicants will be notified of scholarship committee action. Scholarships are competitive and based on financial need and/or academic achievement. The number awarded each year is determined by resources available to the committee. Note: Receiving this scholarship may affect other financial aid that you are receiving.

2 Personal: LAMAR UNIVERSITY MAMIE McFADDIN WARD HEALTH CAREERS SCHOLARSHIP APPLICATION For Administrative Use Only Required Documents SAR Report Notary Name SS# Telephone # LU Banner ID: L Address Birth date Marital Status (circle one) Single Married Separated Divorced Widowed Total number of individuals dependent on income reported in Financial Statement on Page 3: AGE RELATIONSHIP AGE RELATIONSHIP Occupation Position Employer Business Address Self Spouse Mother Father Educational: Provide a copy of your personal records or verify scores in the Advising Center. SAT Score GPA Program (circle one): BSN RN-BSN MSN Which semester of nursing courses are you currently enrolled? (circle one) Projected Date of Graduation: Previous School/College(s) Attended Dates Attended Degree/Diploma

3 FINANCIAL STATEMENT Please note that ANY discrepancy in the financial statement may void your application. The Committee reserves the right to request additional documentation that may include IRS return and/or Lamar University Student Financial Aid Records. Student s (and Spouse s) Resources (after deductions) Academic Year: Fall to Fall (List ONLY the resources on which you rely for living & educational expenses) EARNINGS: PER ACADEMIC YEAR Student $ Parent $ Spouse $ Other (Identify: i.e. gifts from relatives, benefactors) $ SUPPLEMENTAL EARNINGS: (Identify source) Alimony $ Child Support $ Grant $ Loan $ Real Estate, Rent $ Scholarship $ Social Security $ Trust Fund / Savings Account $ Veterans Administration $ Other (Explain: i.e, AFDC, Food Stamps) $ TOTAL YEARLY RESOURCES $ STUDENT S (& SPOUSE) EXPENSES (Estimate for Academic Year) Books, Fees, Supplies, Tuition (Self) $ Books, Fees, Supplies, Tuition (Spouse, Dependents) $ Clothing $ Food $ Housing $ Losses (Casualty, Fire, Theft) $ Medical, Dental, Hospital $ Utilities $ Other (Explain) $ Loan Repayments (Personal) $ TOTAL YEARLY EXPENSES $

4 Please explain any unusual circumstances which may affect your (and/or your parents or families') financial resources. Please be specific. Employment: List your past work experiences, both paid and volunteer. Date Employed Place of Employment Title and Job Description Full or Part time Salary

5 Describe how these experiences may have prepared you for a health career. Explain why you have chosen your major and give some of the factors which influenced your choice. Include any information which may assist the scholarship committee in the evaluation of your application. State your immediate and long-range goals. (Master's students will address selected Track).

6 CERTIFICATION AND RELEASE I understand that it will be necessary for members of the Nursing Scholarship Committee (hereinafter called the Committee) to review my complete student folder in order to evaluate my application for financial assistance. I also understand that the Committee may be required to supply information from my student folder to the Mamie McFaddin Ward Trust Fund Advisory Committee (hereinafter called the Trust Fund). I hereby authorize the release of my student folder for these purposes. I understand that this authorization will remain in effect unless I submit a written revocation to the Mamie McFaddin Ward Health Careers Office. I understand, however, that the Committee has the responsibility of submitted required reports on scholarship recipients to the Trust Fund and that, when this commitment applies, my authorization cannot be revoked. I understand, too, that any violation of the eligibility requirements established by the Committee, would require me to forfeit any current and/or future Ward Health Careers Scholarship. I further understand that I will be required to reimburse the Committee the full amount of any award received during a semester in which I commit a violation of the eligibility requirements related to academic achievement, class attendance, clinical performance, and compliance with Lamar University policies regarding student behavior. I fully understand the conditions and obligations concomitant with the acceptance of this award. Furthermore, I certify that, to the best of my knowledge, all information submitted with this application is true and correct. APPLICANT NOTARY NOTARY SEAL: STATEMENT OF PARENT, GUARDIAN, OR SPOUSE (if applicable): I do hereby certify that I am the (parent/guardian/spouse) of an applicant for a Mamie McFaddin Ward Health Careers Scholarship. I also certify that I have read and understand the foregoing application materials and that, to the best of my knowledge, all of the information provided herein is accurate and complete. SIGNATURE NOTARY NOTARY SEAL:

7 Tips for Notarizing Documents When you need notary services: DO NOT SIGN the portion of the document requiring notarization until you are in the presence of the Notary. Bring your driver s license or official state ID card with you. The Notary will fill out a line in a book with your address and basic information about the document being signed and will have you sign the line in the book as well as the document. Where to find a notary (please call ahead to confirm availability and fees): Your local bank or credit union may have a notary on staff. Often this service is available to account holders / members at no charge (varies by institution). Mailbox companies may provide notary services, such as the Flagship Mailroom, the UPS Store, etc. (THIS IS NOT AN ENDORSEMENT OF ANY COMPANY.). The LU Student Health Center has a notary available at no charge. The secretary in the Nursing Department Chair s office is also a notary and is available for nursing students only, Monday through Thursday, from 2:00-5:00pm. (no charge) If all else fails, your business telephone book should have a listing for notaries located near your home.