Page 1 – Women’s Hall of Fame Scholarship Application /NURSING

NURSING SCHOLARSHIP APPLICATION:

2009 wOMEN’S HALL OF FAME

INSTRUCTIONS FOR SUBMITTING APPLICATION

Handwritten or incomplete applications will not be considered.

Application may be completed online but must be mailed with attachments:

ELIGIBILITY REQUIREMENTS

  • Must be female
  • Must have completed a minimum of one semester of an RN nursing program
  • Must have WestchesterCounty as applicant’s permanent address
  • Must be a U.S. citizen or a permanent resident (Copy of Alien Registration Card required)
  • Application must be submitted byWednesday, December 17, 2008

APPLICATION REQUIREMENTS:

  • Applicant’s personal information page including essayandlist of community

and academic accomplishments

  • Financial forms: (2007) 1040 income tax return & W-2 of each parent or guardian

providing financial support. If applicant is emancipated, include only your tax information

(Alltax informationwill be shredded after the event)

  • Copy of Alien Registration Card, if applicable
  • Official college transcript
  • Nominator’s response to questions

Process for Selecting Scholarship Recipients

Submissions are reviewed and chosen by the scholarship sponsor.

Recipients and Nominators will be contacted by telephone in late February.

APPLICATION CHECKLIST:Be sure to include the following items

APPLICANT’SPERSONAL information page

APPLICANT’Spersonal essay INCLUDINGlist of COMMUNITY & ACADEMIC ACCOMPLISHMENTS

CopIES of (2007) 1040 income tax return w-2 form

Copy of Alien Registration Card, if applicable

Nominator’s response to questions

THREE SIGNATURES – APPLICANT, PARENT OR GUARDIAN(if applicable) AND NOMINATOR

(see Bottom of Applicant’s personal Information sheet)

Applicant’s PERSONAL INFORMATION

Name

Address

City, State Zip

Home Phone

/

Other Phone

E-mail

College Attending/Year Graduating

Legal Status U.S. Citizen Permanent Resident(Copy of Alien Registration Card required)

(Required only if applicant is claimed as a dependent)

Father’s Name / Occupation
Mother’s Name / Occupation
Guardian’s Name / Occupation
Parent Marital Status: Married Divorced/Separated/Single. Applicant resides with

SCHOLARSHIP CRITERIA

Visiting Nurse Services in Westchester Nurse of the Future Award: Two at $5,000 each
A woman who meets the following requirements is eligible to apply:
- Must be a citizen or legal resident of Westchester County, New York, USA;
- Must be a student who has entered a nursing program immediately following high school or
a student who has returned to school later in life after overcoming obstacles and has entered into a nursing program;
- Has completed a minimum of one semester of an RN nursing program toward an associate or baccalaureate degree;
- Must be economically or socially disadvantaged; and
- Demonstrates academic achievement and financial need.
The commitment to the recipient is for one year only, however, an awardee can re-apply.

If awarded a scholarship, I will be present at the Women’s Hall of Fame & Scholarship

Awards Luncheon to be held on Friday, March 27, 2009 to receive my award.

I hereby certify that all sources of financial information have been indicated in the application, I have read this application, and that it is accurate and complete to the best of my knowledge.

______

Applicant’s signatureDate

______

Parent or Guardian’s signatureDate

______

Nominator’s signature Date

APPLICANT’S PERSONAL ESSAY (must be typed –limited to box below)

Please write an essay describing your academic goals and your personal goals. What inspires you? What interests you? Describe how you have been involved in your community and school. What sets you apart from others? Please describe any extraordinary circumstances or challenges you have faced - such as family, medical and financial concerns - and how you have handled them.

In addition attach a list of your school and community activities (clubs, sports, volunteer work, etc.)

Please Note:Information about scholarship recipient will be excerpted from applicant’s personal essay to be included in a short biography in theprogram journal.

Click here to start typing

Nominator’s Information

Applicant’s name
Nominator’s Name/Title
Educational Facility
(If not affiliated with an educational institution, you must supply a letter from the applicant’s school validating her enrollment)
Address
City, State Zip
E-mail / Phone
Contact Person Regarding Scholarship

(If different from nominator)

Title / Phone
E-mail

QUESTIONS FOR NOMINATOR

Judges value answers with specific data and examples of applicant’s achievements. Answers must be typedin the space provided.

(NO OTHER ATTACHMENTS -EXCEPT FOR QUESTION #5)

1) What area of nursing is the applicant pursuing? What motivated her to choose nursing?

2) What are the future goals of the applicant?

3) How has the applicant shown a commitment to her community?

4) Why do you feel the applicant is deserving of this scholarship?

5) SPECIAL CIRCUMSTANCES: please explain (include documentation if necessary)

NOTE:

Please remember to signPage 2 (Applicant’s Personal Information)

Deadline: Application due by Wednesday, December 17, 2008 to:

WestchesterCounty Office for Women

112 East Post Road, Room 110B

White Plains, New York10601
Attention: Camille F. Murphy, Scholarship Selection Committee