N.K.L. Nursing Scholarship

Transcription

1 N.K.L. Nursing Scholarship The primary purpose of the scholarship fund is to encourage people from all walks of life and economic backgrounds to enter into a career in the nursing profession. To be eligible for a N.K.L. Scholarship, an applicant must: Reside in the service area of Mercy Medical Center - Clinton. Be admitted to a nursing program and scholarship funds be used for education in pursuit of a nursing degree. The Educational Assistance Program with Mercy Medical Center-Clinton may be used for tuition only. If you are eligible for Educational Assistance through MMC-C, you must submit all of your receipts including any tuition, fees, or books at the end of each semester, prior to receiving any reimbursement, to the Human Resource office. The total Scholarship/Educational Assistance Program combined is not to exceed the total cost of tuition, fees, and books. Funds must be used during the fall and spring semesters. Provide three forms of recommendation. Reference to the last page of application Selection of scholarship recipients will not be based on sex, age, race, color, national origin, disability, marital status or religion. Preference in awarding scholarships is given to those accepted to Clinton Community College and other area colleges. Applications must be returned to Mercy Healthcare Foundation 1410 North 4th Street Clinton, IA Applicants will be notified of the Scholarship Committee s decision by May. Incomplete applications are subject to disqualification

2 NKL Scholarship Naomi was born July 23, 1910 in Fairhaven Township in Carroll County, Illinois to Charles and Elizabeth Garwick Dial. She is listed as a 1932 graduate of Jane Lamb Memorial Hospital Training School in its 50 Anniversary booklet. I believe she worked there until marrying Alvin, whom she met while he was a patient at Jane Lamb Hospital. The marriage took place September 30, Their eldest son does not remember her working after he was born. So her nursing career was short lived. Though her career was short, she remained dedicated to nursing and kept up her license for many years and attended reunions until she was near retirement age. She always held other nurses in high regard. An interesting aside: She would not give shots to the calves or cows on the farm. Naomi was elected president of the Chadwick Women s Club in 1953 and served for two years. She was past Matron of Eastern Star and fifty-year member of Star and the White Shrine of Clinton. Naomi served as Salem Township Assessor for many years following the path of her father. She was a member of the United Methodist Church.

3 N.K.L. Nursing Scholarship Application Form Name: Address: City: State: Zip: Phone: Address: Number of Years in Clinton Area: Applicant Information Applicant s Place of Employment Financial Disclosure Sheet Occupation Annual Income Will you be working while attending school? Yes No If yes, please check all that apply: Student employment Part-time Full-time Other Spouse s Information Spouse s Name Place of Employment Occupation Annual Income Parent s Information (answer if you are a dependent) Name of Parents Occupation(s) Place(s) of Employment Number of sisters/brothers at home/ Number of sisters/brothers in college Name of college(s) Parents Annual Income $ The above information is accurate to the best of my knowledge. Add extra sheet to application if necessary. _ Signature Date

4 Mark Appropriate Choice Level you will be entering in college: Freshman Sophomore Junior Senior Graduate Student Have you been accepted to this college: Yes No Is your application pending Yes No College/University you plan to attend Location of College/University: City State This College/University is a: 2 year 4 year Course Hours Earned: College General GPA: Expected Date of Graduation: Degree you will be pursing: ADN BSN MSN Other Field of Study: Will you be enrolled: Full Time (12 hours or more) Part time or more (How many hours?) Less than half-time (less than 6 hours) Tuition Reimbursement from Employer? Yes No Amount $ Have you applied for other scholarships? Yes No Received other scholarships? Yes No If yes, please list from whom and how much: Estimated Expenses for School Year Tuition & Fees Fall Semester Spring Semester Total for Year Books & Supplies Totals

5 Please answer the following questions. 1. Provide a statement of your professional goals. (Applicants should include goals for the nursing professional, such as community involvement and leadership in nursing) 2. List your contributions to the nursing professional and/or community-related activities, including memberships in professional organizations and/or community-related activities. 3. State your beliefs about the role of nursing in the delivery of health care. No writing on the back

6 Student Name Reference Form Student Instructions: Have this section completed by an employer, community/religious leader or another person in a position of authority who knows you and your accomplishments. Someone other than a family member must complete this form. This is the only form that will be accepted. No letters. Academic achievement Extracurricular Accomplishment Personal qualities & character Creativity, original thought Motivation Self-Confidence Independence, Initiative Intellectual ability Kindness Toward Others Disciplined work habits Potential for growth Average Great Excellent Compared to others, how do you rate this student in terms of: Strongly Enthusiastically Your Name Organization Address City State Zip Signature Phone Fax Comments_ No attachments or writing on the back

7 Student Name Reference Form Student Instructions: Have this section completed by an employer, community/religious leader or another person in a position of authority who knows you and your accomplishments. Someone other than a family member must complete this form. This is the only form that will be accepted. No letters. Academic achievement Extracurricular Accomplishment Personal qualities & character Creativity, original thought Motivation Self-Confidence Independence, Initiative Intellectual ability Kindness Toward Others Disciplined work habits Potential for growth Average Great Excellent Compared to others, how do you rate this student in terms of: Strongly Enthusiastically Your Name Organization Address City State Zip Signature Phone Fax Comments_ No attachments or writing on the back

8 Student Name Reference Form Student Instructions: Have this section completed by an employer, community/religious leader or another person in a position of authority who knows you and your accomplishments. Someone other than a family member must complete this form. This is the only form that will be accepted. No letters. Academic achievement Extracurricular Accomplishment Personal qualities & character Creativity, original thought Motivation Self-Confidence Independence, Initiative Intellectual ability Kindness Toward Others Disciplined work habits Potential for growth Average Great Excellent Compared to others, how do you rate this student in terms of: Strongly Enthusiastically Your Name Organization Address City State Zip Signature Phone Fax Comments_ No attachments or writing on the back