J. Russell Fawley Scholarship Application
For Undergraduate Students
Please complete the following form for consideration by Temple University College of Health Professions and Social Work Department of Nursing for a J. Russell Fawley Scholarship for academic year 2012-2013. Established in 2007 by the J. Russell Fawley Trust to provide scholarships to BSN Program students based on academic merit and financial need with preference given to students who are permanent residents of the Roxborough, Manayunk, and East Falls areas of Philadelphia, PA. Qualified applicants who are permanent residents from the five-county areas of Philadelphia, Bucks, Chester, Delaware, and Montgomery will also be considered.
Deadline for Submission: February 29, 2012
  1. Name: ______
    (print)
Signature: ______
Date: ______
  1. Mailing Address during academic year (September-May):
______
Street
______
City
______
State, Zip Code
  1. Temple University E-mail address: ______
  1. Preferred telephone number: ______
  1. Fall 2012 BSN Program class standing: Junior Senior
  1. Expected Graduation Date: (Month/Year) ______
  1. Personal Essay of no more than 250 words describing your career plans in nursing, as well as your long-term aspirations.
  1. Please attach a brief personal statement regarding your financial need, if appropriate. This statement must address how this scholarship would aid you to meet your academic goals.
  1. Are you currently receiving financial aid? Yes No
  1. For the current academic year you are applying for the J. Russell Fawley Scholarship,
    please provide the following information, if it is relevant to you:
Amount of Loans awarded: $______
Amount of Grants awarded: $______
Amount of Scholarships awarded: $______
Amount of Other awards: $______
  1. Submit your current academic transcript from Temple University (note: a student copy is acceptable).
  1. Attached two letters of recommendation; at least one must be from a faculty member (see attached form). These recommendations must be sent directly from the recommending individuals directly to the address provided on the form.
Please send completed application and attachments (i.e., Resume [if appropriate], Personal Essay, Personal Statement Regarding Financial Need [if appropriate], and Current Temple University Transcript [student copy acceptable]) to:
Ms. Andrea Darden
Department of Nursing
Temple University
College of Health Professions and Social Work
3307 North Broad Street
Philadelphia, Pennsylvania 19140
For additional information regarding this application, please contact
Ms. AndreaDarden at 215-707-4687 or e-mail at .
J. Russell Fawley Scholarship Application
Recommendation Form
Name of Applicant: ______
(print)
Name of Recommending Individual: ______
(print)
I, ______(Student’s Signature), give permission for the above-named individual to provide a reference.
Individual Completing the Recommendation Form:
  1. Name: ______
    (print)
  1. Title: ______
    (print)
    Institution: ______
    (print)
  1. Mailing Address:
______
Street
______
City
______
State, Zip Code
  1. E-mail address: ______
  1. Telephone number: ______
  1. FAX number: ______
Evaluation: In comparison with a representative group of undergraduate students who have had approximately the same amount of experience and training, how do you rate the applicant in:
Item / Excellent
Upper 5% / Above Average Upper 10% / Average
Upper 25%
• General academic ability
• Leadership potential
• Motivation and initiative
• Ability to work with others
• Imagination and creativity
• Potential to succeed
Additional Comments: (Please do not attach additional letters)
Please use the rest of this form to comment on any aspect of the applicant’s background, experiences, community involvement, etc., that you feel will assist the review committee evaluate this student’s application. Thank you.
______
______
______
______
______
______
______
______
______
______
______
______
Signature: ______Date: ______
Please return this form to:
Ms. Andrea Darden
Department of Nursing
Temple University
College of Health Professions and Social Work
3307 North Broad Street
Philadelphia, Pennsylvania 19140
Thank you.
J. Russell Fawley Scholarship Application
Recommendation Form
Name of Applicant: ______
(print)
Name of Recommending Individual: ______
(print)
I, ______(Student’s Signature), give permission for the above-named individual to provide a reference.
Individual Completing the Recommendation Form:
  1. Name: ______
    (print)
  1. Title: ______
    (print)
    Institution: ______
    (print)
  1. Mailing Address:
______
Street
______
City
______
State, Zip Code
  1. E-mail address: ______
  1. Telephone number: ______
  1. FAX number: ______
Evaluation: In comparison with a representative group of undergraduate students who have had approximately the same amount of experience and training, how do you rate the applicant in:
Item / Excellent
Upper 5% / Above Average Upper 10% / Average
Upper 25%
• General academic ability
• Leadership potential
• Motivation and initiative
• Ability to work with others
• Imagination and creativity
• Potential to succeed
Additional Comments: (Please do not attach additional letters)
Please use the rest of this form to comment on any aspect of the applicant’s background, experiences, community involvement, etc., that you feel will assist the review committee evaluate this student’s application. Thank you.
______
______
______
______
______
______
______
______
______
______
______
______
Signature: ______Date: ______
Please return this form to:
Ms. Andrea Darden
Department of Nursing
Temple University
College of Health Professions and Social Work
3307 North Broad Street
Philadelphia, Pennsylvania 19140
Thank you.