THE CELESTYNE WEBSTER TAYLOR NURSING EDUCATION SCHOLARSHIP PROGRAM INFORMATION ACADEMIC YEAR

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1 THE CELESTYNE WEBSTER TAYLOR NURSING EDUCATION SCHOLARSHIP PROGRAM INFORMATION ACADEMIC YEAR The attached application must be postmarked by June 30, 2013 PURPOSE OF SCHOLARSHIP The goal of the Celestyne Webster Taylor Nursing Education Scholarship is to honor the memory of Celestyne Taylor, who served as a public health nurse for the City of Chicago for over 40 years, and to increase the number of nurses available for service to the profession by offering scholarships to overcome financial barriers to education. This scholarship provides financial assistance to qualified individuals pursuing an associate degree in nursing, an associate degree in applied sciences in nursing, a hospital-based diploma in nursing, a baccalaureate degree in nursing, a graduate degree in nursing or a certificate in practical nursing. This scholarship is funded through contributions by the family and friends of Celestyne Webster Taylor, including members of the St. Mark Chancel Choir, in which Celestyne Webster Taylor served as faithful member for over 50 years. ELIGIBILITY An applicant must be: 1. a resident of Illinois for at least one year prior to application, and be a citizen or lawful permanent resident alien of the United States; 2. enrolled in or accepted for admission to a nursing program accredited by the State of Illinois; and 3. in need of financial assistance based on applicant's Student Aid Report. APPLICATION To be considered in the selection process, an applicant must: 1. submit a completed, signed and dated application form prior to the deadline; 2. include a current copy of an official transcript or other current official school form that indicates a cumulative grade point average (GPA); 3. include a copy of a Free Application for Federal Student Aid (FAFSA) that indicates an Estimated Financial Contribution (EFC); and 4. if licensed, include a copy of his/her Illinois registered professional nurse license or Illinois practical nurse license. 5. An essay of no more than 500 words explaining why the applicant is pursuing a career in nursing. 1

2 SELECTION CRITERIA Recipient(s) will be selected based on the following criteria: 1. greatest financial need per the Federal Student Aid Form; 2. the cumulative grade point average as documented on an official transcript or other official school form. 3. the strength of the essay submitted SCHOLARSHIP AMOUNTS Full-time students may receive up to $2500 for tuition and fees. 2

3 APPLICATION APPLICANT Name (First) (Middle Initial) (Last) Mailing address (Street Address/Apt./P.O. Box) (City) (State) (Zip) Date of Birth County of residence Telephone Cell phone address (required) Female Male Single Married Number of dependents (do not count yourself) Citizenship: Are you a citizen of the United States? Yes No If no, are you a lawful permanent resident alien? Yes No How long have you lived in Illinois? years and/or months 3

4 B. EDUCATION In which nursing program will you be enrolled during academic year ? Associate degree program Hospital-based diploma program Baccalaureate degree program Masters degree in nurse education Masters degree as advanced practice nurse Doctoral degree in nursing or philosophy Practical nursing program Anticipated date of graduation with your nursing degree (Month) (Year) Name and city of nursing school where you will be enrolled During academic year , will you be enrolled: Full-time (12 credit hours or more) Part-time (4-11 credit hours) Have you had prior nursing education? Yes No If yes, what type: Associate degree in nursing Hospital-based diploma in nursing Baccalaureate degree in nursing Certificate in practical nursing 4

5 Do you have a current Illinois nurse license? Yes No If yes: Registered professional nurse license Practical nurse license If yes, provide a copy of your Illinois nurse license with this application. Applicant's Signature Date I certify that the information submitted in this application is a true record. Applicant's Signature Date Application must be postmarked on or before June 30,

6 Mail applications to each of the following persons: Attorney Barbara Johnson Partner, Employment Law Department Paul Hastings LLP th Street Washington, D.C Dr. Kathryn Malone 6339 Cleveland Street Merrillville, Indiana Phone: 1 (219) Mr. Ralph Cross S. Harvard Chicago, Illinois

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