This scholarship is intended to financially support students living in, or members of, TNA District 1 who are working to complete a BSN/MSN entry-level degree, RN to BSN, or a graduate/post graduate nursing degree. All requests must be made through TNA District 1 Scholarship committee. Applicants must meet eligibility criteria, complete the application, and agree to the terms of the scholarship request. This is a onetime non-repayable scholarship. All applicants will be notified of decisions no later than December 7, 2016. Checks will be mailed to individuals by December 15, 2016.

THIS APPLICATION FORM IS AVAILABLE ONLINE AT .

Applicants Name (First, MI, Last)
Home address (number/street)
City, State, & Zip
Phone (Home with area code) / Mobile
Permanent email address
Nursing Program in TNA District 1 currently attending (or accredited online program)
For Term Beginning
Expected Graduation Date / Degree
If applying for Graduate or Post-Graduate: Major / Degree
Objective
I have been a continuous member of TNA, for at least one year (not required for District 1 funded scholarship) / Member #
Date Joined
OR I am a member of SNA (preferred for pre-licensure,not required) / YES / NO
Current GPA (if applicable- attach transcript)
Please indicate which scholarship(s) you are applying for:
Tennessee Nurses Foundation
TNA District 1 Educational Scholarship
Pre-licensure BSN/MSN
RN to BSN
Graduate/Post-Graduate
Please complete checklist below before submitting your application:
Completed application form / Submit an essay (minimum 300-500 words) to include
3 letters of reference from faculty / Blinded
Most recent transcript / Unblinded
Proof of acceptance/enrollment / Signed application form

My signature indicates that if selected, I will use the scholarship money for educational purposes only

______

Signature of the Scholarship Applicant Date

DEADLINE FOR SUBMISSION: Submissions should be postmarked no later than November 18, 2016

Submit completed packet to Dr. Tommie Norris, TNA District 1 Scholarship Committee,

THIS PORTION TO BE COMPLETED BY RECOMMENDER

To the Recommender: We would appreciate your opinion of the above applicant for TNA District 1 Scholarship(s) to pursue a BSN/MSN entry-level degree, RN to BSN, or Graduate/Post-Graduate degree in nursing.

We are particularly interested in an evaluation of the applicant’s potential for academic and professional achievement in nursing (or the nursing specialty indicated). PLEASE DO NOT use applicant’s name in your written comments as this form will be blinded for review. Forms must be postmarked on or before November 18, 2016.

Excellent / Above average / Average / Below average / Poor / No Basis for Judgment
Intellectual ability
Imagination & Creativity
Verbal communication
Skills
Writing ability
Quality of work
Nursing practice or potential for practice

Additional comments regarding character, integrity, or motivation are appreciated if pertinent. Limit typed (or written) comments to space below. DO NOT include applicants name in your comments. Write “applicant” or “he/she” instead of applicant’s name.

How long have you know the applicant? ______

In what capacity have you known the applicant? ______