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1 SOUTHERN MID-ATLAI\{TIC NAVY NURSE CORPS ASSOCIATION To: Directors of Nuning, Deans, Chairs of Nursing Program, Veterans Service Organizations, Nurse ROTC Program Directors and Others From: Southem Mid-Atlantic Navy Nurse Corps Association Scholarship Committee The Southem Mid-Atlantic Narry Nurse Corps Association has established a fund to award scholarships to desering nursing students to continue their studies for a baccalaureate desree in nwsing OR for students who have a NON-nursing baccalaureate degree and are pursuinga masters in nursing as ENTRY into the profession. Nursing programs must be NLNAC or CCNE accredited. The amount of the award will be Two scholarships will be awarded. Enclosed is information along with the application for the scholarship. This may be duplicated or more copies may be obtained from the Scholarship Committee Chairperson. Only completed applications and forms will be considered. Any questions or electronic applications can be provided by Carlos A. Torres at los787@aol.com or Anolications must be returned no later than Mondav. March Annonncernent ofthe selections will be made by April24,2016 Send applications to: SMANNCA Scholarship Committee cio Carlos A. Torres, Chairperson 5713 Rossburn Court Virginia Beach, VA Enclosures: (l) Past Recipients (2) Guidelines (3) Application (4) Reference Forms (5) Financial Assistance Questionnaire (6) Applicant's checklist Sincerely,.--..'.-.. /o.xlprl< ls\\r=f Carlos A. Tones, RN, MSN, PAHN Captain, Nurse Corps, US Navy-Retired SMANNCA Scholarship Committee Chair

2 SOUTHERI\J MID.ATI,AN?IC NNCA SCHOLARHIP RECIPIENTS 2007 Courtney Crumpton University of Virginia 2008 Nneka Okoye Thomas Jefferson College 2009 Tierra Veney 20lo Camille Crump 20lr Lindsay Nordstrom 2012 Conrad Simon 2013 Bethany Bovier University of Virginia Hampton University Shenandoah University University of North Carolin4 Chapel Hill James Madison University 2014 Jayne Green (SMANNCA) North Carolina Central University Christine Ruff (MIMG) Liberty University 2015 Rachel L. Fisk (SMANNCA) James Madison University Camile Cogbum (MIMG) UNC, Chapel Hill Ent{na'r*tt)

3 SOUTIIERN MID.ATLAIYTIC NA\ry NURSE CORPS ASSOCIATION GUIDELINES scholarship-a scholarship is being offered to undergraduate nwsing student to continue their studies for a baccalaureate degree in nursing or for students who have a non-nursing baccalaureate degree and are pursuing a master in nursing as ENTRy level into the profession. Recipients of scholarships will be selected by the Southem Mid-Atlantic Navy Nurse Corps Association (SMANNCA) Scholarship Committee. Aoolicants: 1. Must be enrolled in an NLNAC or CCNE accredited nursing program 2. Must be a Virginia or North Carolina Collegefuniversity 3. Must be a Nursing Major 4. May be a firll or part time student 5. Must have a crurent grade point average ofat least 3,0 on a 4.0 scale 6. Must give evidence of successful COMPLETION of at least one CLINICAL nursing course AoBlication-Applicants must submit a completed application form on or before the due date. Any additional data and/or comments that support the application are strongly encouraged. only GOMPLETED applications (including references and transcrips) will be accepre4 which includes signatures on all signature lines. Attached referencqforms MUST be comfleted and retumed. Incomplete materials will not be considered. Applicants for scholarships for the Baccalaureate Degrce or MSN (basic entry into practice) must submit: l. Completed application form 2. OFFICAL transcript from current program and other college/university transcripts 3. Two professional nursing references (mailed directly to below address). one must be from a faculty member. Iftwo are not received. the package will be considered incomplete. 4. A personal statement of 500 words or less giving reasotrs you are qualified for the scholarship as well as how the scholarship will benefit you. please include career goals and potential for contribution to the profession. 5. A completed Financial Assistance Questionnaire Application deadline is Nls'rch 27,,2O16. Only applications received on or before the deadline will be accepted. Retum completed application and all related docunents in one mailing to: Southem Mid-Atlantic NNCA Scholarship Committee c/o Carlos Torres 5713 Rossbum Court Virginia Beach, Y A t- " /.\ Ladsz6*\t't

4 SOUTIIERN MID.ATLA.I\ITIC NAVY NURSf, CORPS ASSOCIATION SCHOLARSEIP APPLICATON FOR DEGRf,E IN NURSING (Please qpe or print clearly) ***DIIE NLT Mancb 27,2016** Applicants Full Name: Home Address: Mailing Address: Phone ( ) - Education: Current School: GPA (using 4.0 scale): Other Post High Schools Attended: (include # credits and degree) Last First (Maiden Name) Street City State zip Date(s) of Attendance: Anticipat d Graduation Date: zip Official transcripts and proof of enrollrnent must be senttol SMANNCA Scholarship Commitree c/o Carlos A. Torres, Chairperson 5713 Rossburn Court Virginia Beach, VA 2J455 Employment Rccord: List in chronological order with present employment first. Place Dates position part/full Time Use reverse side if necessary. Community Involvement/Tamily Responsibilities : Activitv Place position Hrs- Per Month Dates Use reverrc side if necessar.5r. Military/Civit Service Allitiation: (if any) Elaborate on your military affiliation. Honors/Awerds/Recognitions: (high schooito preseng Honor Date # Years rttestitg to compet ncy in nursiag. (please see attached form.) I veri! that all staternents made in this application are complete and accurate. Signature:_ Date: onal refernences

5 SOUTHERN MID.ATLAI{TIC NAVY NURSf, CORPS ASSOCIATION SCHOLARSIIIP REFERENCE FORM Submit 2 professional SIGNED nursing references using the form below. One must be from a facultv member in nursins. please print or type. The st rdent o, effiiffit retum this form no later than 27 March20l6 (post marked). Late submissions will Nor be considered. Candidate: Address: Last Name Fint Name MI City Name of Person Writing Reference: SchooVlnstitution/Business : Position: Address: State Phone Number: zip City How long have you known applicant? In what capacity2 _ State zip Please address the following on a scale of l-3 (3 being the best rating): Attitude Character(Honesty/Integrity) CompetencylPerformance NiA Good 1. Clinical Application 2. Theory Professionalism Leadership Management Self-direction Please aftach a typewritten narative describing the candidate in light of your mting. Signature Date Note: Please send this reference to: SMANNCA Scholarship Committee c/o Carlos A. Torres 5713 Rossbum Court Virginia Beach, Y A n.t" rrpg)

6 SOUTI{ERN MID-ATLANTIC NAVY NURSE CORPS ASSOCIATION FINANCIAL ASSISTANCE QUESTIONAIRE Since the need for scholarship^fimds is a component ofthe factors considered in awarding scholarships, the following information is required. This page of the application, *hen - completed, is made available only to the Scholarship committee of the Southem Mid- Atlantic Navy Nurse corps Association. The information will be held in strict confidence. Applicant's Name: Address: Street City Dp Are you relying s1 yo* narent's financial support for education expenses? How many other students in your family wili be relying on you or your parents for financial support for education expenses this year? Number of Dependents (those financially dependent upon you), Relationship(s): Estimated costs for the 2016 academic calendsr vear; Tuition and fees: Books and supplies: Room and board: TraveVcommuting: Personal Expense: Total: Source of funding to meet thcse expenses! Expected contributions from farnily members: Expected contributions from your earnings: Expected contributions from your savingi: Awards, scholarships, grants received: Other sources of funding (please identiff)l Total { 6ta-q-(O

7 Scholarship Checklist Applicant's Name: o Application Sheet o Personal Statement o OfficialTranscripts o (1) Faculty Letter of Recommendation o (1) Professional or Faculty 2nd Letter of Recommendation o Financial Need Questionnaire 2016 Cycle Note: There must be a TOTAL of TWO letters of recommendation per applicant.