Transcription

1 September 10, 2014 Dear Nursing Program Administrator, Greetings from Region 5 of the. It is with pleasure that it is announced the availability of three $1,000 scholarships for which nursing students from Region 5 may apply. Region 5 includes residents of Camden, Burlington, Cumberland, Gloucester and Salem counties. Potential candidates include current nursing students at any level of matriculation and need not be current members of the. Please forward to your student body. Interested individuals will need to complete the attached application or download the application from the website and submit the application along with supporting documentation to the following recipient/address: Jan Masters, MSN, RN, CENP 413 Farmhouse Lane Mount Laurel, NJ The deadline for applications and supporting documentation is November 30, Best of luck to all applicants. Sincerely, Corleta Jones BSN,RN and the Institute for Nursing 1479 Pennington Rd., Trenton, New Jersey P: (856) F: (609) universalhealth3@live.com

2 NJSNA Region 5 Scholarship Application Date: Application must be typed or reproduced by computer. Do not staple any pages. SECTION I Name: Mailing Address: City: State: Zip: Permanent (home) Address: City: Zip: Home Phone: State: Cell Phone: address: County: Student presently: rents owns home lives in dorm lives with parents Date of Birth (mm/dd/yyyy) Marital/Civil Union Status: Number of Student's Dependents (Including self): **If you are currently a registered nurse please provide NJSNA membership # and Region #.

3 SECTION II - CURRENT SCHOOL School of Nursing: County: Type of Nursing: Diploma Associate Degree Baccalaureate Masters Degree Doctorate Program Year in School Length of Program (years) 2 2½ Type of School: State Private Attending: Full Time Part Time Approximate GPA (using 4.0 scale) Date of anticipated graduation: Send: an unofficial copy of your previous semester s transcript. a letter from the dean or designee. The letter must be included with this application and address the ability of the applicant to succeed in the program, leadership potential of the applicant, and verification of GPA and the cost of the program. Dean/Designee Name: Title: Mailing Address: City/State/Zip: Phone Number:

4 SECTION III - EDUCATIONAL BACKGROUND Name of schools of nursing and/or colleges attended: 1. Name of School: Did you graduate? Yes No If so, what year? City: State Zip Type of degree/certification/diploma: 2. Name of School: Did you graduate? Yes No If so, what year? City: State Zip Type of degree/certification/diploma: 3. Name of School: Did you graduate? Yes No If so, what year? City: State Zip Type of degree/certification/diploma: SECTION IV INCOME and EXPENSES Please list all projected income (including spouse or parents if you are a dependent) and expenses, including expenses for education, personal, and household, for the next academic year, plus outstanding student loans, and any current scholarships (include only monies that have already been approved. Incomplete financial information will invalidate application. Please total both sections (i.e. total income and total expenses). SEND most recent Federal Income Tax Return (with social security number removed or blackened) - first two pages only; if you are a dependent, attach a copy of parent s or guardian s return.

5 INCOME Income: Current scholarships: Total Annual Income: EXPENSES Education Tuition: Books: Housing/Rent: Transportation: Student Loans: Miscellaneous Personal (be specific) Household (be specific) Total Annual Expenses: SECTION V MISCELLANEOUS A. Work experience (if applicable) 1. Employer: Type of Work

6 Length of Employment Reason for leaving 2. Employer: Type of Work Length of Employment Reason for leaving B. Additional Information Activities:- Memberships\Student Professional Organizations: Committees/Offices: Awards: (Please identify the amount of any scholarship awards) If you have previously received a scholarship from NJSNA Region 5 or other NJSNA Regions, indicate year, amount, and type of scholarship: