TRINTY VALLEY COMMUNITY COLLEGE

HEALTH OCCUPATIONS DIVISION

APPLICATION FOR SCHOLARSHIPS

Complete all information below. Submit with the requested attachments to the HSC Provost by the required deadlines.

Name: ______TVIN: ______

TVCC Health Occupations Program: ______

Residence is in the ______School District. Cumulative GPA: ______

Marital Status: ______Ages of children: ______

Sources & Amounts of Income:

______Current Annual Family
Income
______Child Support (Monthly)
______Pell Grant (Semester)
______Loan / ______Other Scholarship:
______
______WIA
______Food Stamps/Govt.
Subsidy (Monthly)

Describe factors that contribute to your need for the scholarship for which you are applying:

List the direct educational expenses for which you are requesting this scholarship (i.e. tuition & fees, books, licensure application fees, testing fees, etc.)

Which scholarship(s) are you applying for? (See back for qualifications):

______

ATTACH:

1.  For the Mary Hardy Scholarship attach a short essay (no more than one page) on what nursing means to you and why you want to be a nurse.

2.  For the Weldon Ford Scholarship attach an idea for how you plan to engage in the study of cystic fibrosis and a statement that you are a non-smoker.

3.  For Dr. Edward I. and Nettie Hall Scholarship attach a cover letter explaining why you deserve this scholarship and a letter of recommendation

4.  For the Cain Foundation Scholarship, attach a cover letter explaining how this scholarship will make a difference in your nursing education.

State law requires that each student identify any relation to a current Board of Trustees member. A student who is related to a current member of the governing board of that institution 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. Please review a list of current Trinity Valley Community College Board of Trustees members at www.tvcc.edu/about/trustees.aspx and then select the most appropriate answer below indicating your relation to any of the Board of Trustees members.

❏ Not related to a Trustee

❏ Trustee’s mother, father, daughter or son ❏ Trustee’s brother, sister, grandparent or grandchild

❏ Trustee’s great-grandchild, uncle (brother of parent), aunt (sister of parent), nephew (son of brother or sister), or niece (daughter of brother or sister)

❏ Trustee’s spouse; spouse’s child; spouse’s mother or father; child’s spouse; or parent’s spouse

❏ Trustee’s spouse’s brother or sister; spouse’s grandparent; spouse’s grandchild; brother or sister’s spouse; grandparent’s spouse; or grandchild’s spouse

Date______Signature of Applicant______

TVCC is an affirmative action/equal opportunity institution which provides educational and employment opportunities on the basis of merit and without discrimination or harassment because of race, color, religion, sex, national origin, age, or disability.

QUALIFICATIONS FOR SCHOLARSHIPS

1.  Weldon Ford Memorial Nursing Scholarship - $300/semester for Level III & IV

A.  Be a sophomore ADN student at TVCC.

B.  Engage in the study of cystic fibrosis through experience such as CF Awareness Day, outpatient clinic, or special events (may be done after scholarship is awarded).

C.  Demonstrate need and/or academic ability.

D.  Be a non-smoker.

E.  Apply by April 15th before sophomore nursing courses. Include required statements. Awarded at the beginning of the sophomore fall and spring semesters.

2.  Mary Hardy Nursing Scholarship - $300 for Level II

A.  Be enrolled in Level II courses in the ADN program at TVCC.

B.  Demonstrate need and/or academic ability.

C.  Apply by November 15th before Level II semester. Include required essay. Awarded at the beginning of the spring freshman semester.

3.  Health Science Center – Variable for direct educational expenses only

A.  Be enrolled in a health occupations program at TVCC.

B.  Demonstrate need and/or academic ability.

C.  Apply by November 15th or April 15th for the next semester or as needed in emergency cases. Awarded at the beginning of each semester or as needed.

4.  William O. and Ora Mae Miller Scholarship – Variable for direct educational expenses only

A.  Be accepted into the ADN program and enrolled in ADN courses

B.  Demonstrate financial need.

C.  Demonstrate academic promise by having and keeping at least a 2.5 cumulative GPA.

D.  Apply by November 15th or April 15th for the next semester. Awarded at the beginning of each semester.

5.  W. R. Kinabrew Nursing Scholarship – Variable

A.  Be an ADN student at TVCC.

B.  Be a resident of the TVCC tax district.

C.  Demonstrate need and be in good standing academically.

D.  Apply by November 15th or April 15th for the next semester. Awarded at the beginning of each semester or as needed.

6.  Vocational Nursing Scholarship – Kaufman and Palestine - Variable

A.  Be enrolled in the second or third semesters of one of the vocational nursing programs.

B.  Demonstrate need and be in good standing academically.

C.  Apply by the end of the first semester (November 15th or April 15th) or as needed in emergency cases. Awarded at the beginning of the second semester or as needed.

7.  Dr. Edward I. and Nettie Hall Scholarship - $250 each semester starting with Level I

A.  Be accepted into ADN courses at TVCC.

B.  Demonstrate need and academic ability.

C.  Apply by June 1st before first year of ADN program. Include letter of recommendation and cover letter.

8.  Cain Foundation Scholarship - $500 per semester

A.  Be going to enroll in ADN program in Level III or IV and must live in Athens

B.  Demonstrate need and academic ability

C.  Apply before November 15th or July 15th for the next semester

______

For office use only: Semester: ______Scholarship Awarded: ______Amount: ______

Scholarship Award Form Sent to Financial Aid: ______Notification Sent to Student: _____

f:scholarship application.doc Revised 04/11