ALUMNI ASSOCIATION OF THE SCHOOL OF NURSING OF THE HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA NURSING SCHOLARSHIP

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1 ALUMNI ASSOCIATION OF THE SCHOOL OF NURSING OF THE HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA NURSING SCHOLARSHIP In 1993, the Board of Directors of the Nurses' Alumni Association of the Hospital of the University of Pennsylvania formed a task force to investigate options on how the organization might benefit nursing education and the community. The task force reviewed current activities of the Association, restrictions in its charter and its financial assets. After thorough investigation and careful consideration, the task force recommended the creation of the Alumni Association of the School of Nursing of the Hospital of the University of Pennsylvania Nursing Scholarship Fund. The fund was placed with The Philadelphia Foundation. The Philadelphia Foundation, a community foundation, was established in 1918 and serves the southeastern Pennsylvania region. It is comprised of over 800 individually named charitable funds. For more information, please visit our website at The Scholarship Fund was designed to provide support and promote nursing. For the academic year, one or more scholarships ranging from $500 to $1,000 will be awarded. The Fund will provide scholarships for tuition assistance to persons entering nursing or for those who are accepted in or enrolled in an NLN-accredited program (LPN, AD, diploma or BSN). Recipients shall be selected on the basis of financial need, interest in the nursing profession, and acceptance in an NLN-accredited program. Scholarships shall be given in the following order of priority: (1st) a candidate who is a relative of a graduate of the School of Nursing of the Hospital of the University of Pennsylvania; for example a child, grandchild, niece or nephew (2nd) a candidate proposed by a graduate (3rd) a candidate who is a resident of Bucks, Chester, Delaware, Montgomery or Philadelphia county in Pennsylvania; Burlington, Camden or Gloucester county in New Jersey or New Castle county in Delaware. Over time, scholarships have been awarded to applicants from all priority areas. Completed applications and recommendations must be submitted to the Foundation by May 17, Market Street, Suite 1800, Philadelphia, PA p , f ,

2 Alumni Association of the School of Nursing of the Page 2 Hospital of the University of Pennsylvania Nursing Scholarship The Advisory Committee will review applications and make its decisions by June 28, All applicants will be notified in writing of the decisions. The scholarship award will be forwarded directly to the educational institution in the summer of 2013 to be applied to tuition costs for the academic year. Applications may be requested by phone, FAX, or in writing. By May 17, 2013, completed applications, transcripts and recommendations must be received by mail or delivered to: The Philadelphia Foundation Attn: Alumni HUP Nursing Scholarship 1234 Market Street, Suite 1800 Philadelphia, PA Phone: Fax: sspivey@philafound.org 01/2013

3 ALUMNI ASSOCIATION OF THE SCHOOL OF NURSING OF THE HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA NURSING SCHOLARSHIP SCHOLARSHIP APPLICATION APPLICATION DEADLINE: May 17, 2013 CHECKLIST Completed all questions on the application form Requested an official high school transcript Requested an official post-secondary transcript (if applicable) Attached a copy of your school s estimated costs and a description of how you plan to meet them Attached your statement of ASPIRATIONS AND GOALS Attached a letter of support from your sponsor Supplied Recommendation Forms to each of your two references Signed and dated the application form By May 17, 2013, mail or deliver your completed application with attachments to: The Philadelphia Foundation Alumni HUP Nursing Scholarship 1234 Market Street, Suite 1800 Philadelphia, PA Please print or type. Application is seven pages long. APPLICANT INFORMATION Name Last First Middle Permanent Address Street City County State Zip Telephone ( ) Date of birth 1234 Market Street, Suite 1800, Philadelphia, PA p , f ,

4 FAMILY INFORMATION Please circle relationship. Father /Stepfather /Guardian Address Mother/Stepmother/Guardian Address Check if applicable: father deceased mother deceased parents separated parents divorced Number of siblings financially dependent on parent(s)/guardian OR Name of spouse Address OR Number of individuals financially dependent on you HIGH SCHOOL INFORMATION Please have a copy of your official transcript mailed directly from your high school to the Foundation. High school attended Year of graduation Telephone ( )

5 HIGH SCHOOL ACTIVITIES In the space provided below, please list extracurricular activities in which you have participated during the past four years. Include clinical and practical experiences, and student organizations. You may attach a separate listing or your resume. Activity # of Years/ Months Leadership Positions, Letters Earned, Recognition, etc. COMMUNITY AND PERSONAL ACTIVITIES In the space provided below, please list community, religious and personal activities in which you have participated during the past four years. Include volunteer work, particularly clinical and practical experience, youth programs, athletic programs, music, scouting, community service, etc. You may attach a separate listing or your resume. Activity # of Years/ Months Leadership Positions Awards, Honors, Recognition, etc.

6 WORK EXPERIENCE In the space provided below, please list any paid work experience (include self-employment, i.e. baby sitting) you have had during the past four years. Include summer employment as well as employment during the school year. Complete this information beginning with your most recent work experience. You may attach a separate listing or your resume. Employer Nature of Work (include supervisory positions) Dates of Employment Hours per Week POST SECONDARY EDUCATION INFORMATION If you are currently in a program, please have your official transcript mailed directly to the Foundation. Program you plan to attend or are currently attending. Institution Address Telephone ( ) Will you be a full-time student? Yes No When do you anticipate completing your program?

7 POST SECONDARY EDUCATION FINANCIAL AID INFORMATION Have you received or been promised other financial aid (scholarships, loans, grants, etc.)? Yes No If you have answered YES above, please provide the following information regarding other financial assistance. You may attach a separate page if necessary. Amount Date Received Term Purpose FINANCIAL INFORMATION -- PERSONAL Financial need is one of the criteria for scholarship selection. Please attach a copy of your school s estimated cost of attendance. How do you plan to meet these expenses (scholarships, loans, grants, employment, family, etc.)? Please circle YES or NO: Did or will your parents/guardian claim you as an income tax exemption? Yes/No Yes/No Did or will you get more than $1,000 worth of support from your parents/guardian? Yes/No Yes/No Did you live with your parents/guardian for more than six weeks in either year? Yes/No Yes/No ASPIRATIONS AND GOALS Please submit a statement on an attached sheet describing your personal aspirations and educational and career goals. This statement should be 1-2 typewritten, double-spaced pages and must include information that will answer each of the following questions: Why are you pursuing a career in nursing? In what area of nursing do you plan to specialize?

8 In the space below, please report any additional information or factors which you believe should be considered by the Advisory Committee in reviewing your application. HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA SCHOOL OF NURSING - SPONSOR 1. Are you related to a graduate of the Hospital of the University of Pennsylvania School of Nursing? Yes No OR 2. Are you being proposed for this scholarship by a graduate of the Hospital of the University of Pennsylvania School of Nursing? Yes No NOTE: if possible, please enclose a letter of support from your sponsor. Sponsor's name at graduation: Year of graduation Relationship Sponsor s current name Sponsor s current address Sponsor s current telephone ( )

9 REFERENCES Please provide the following information for each of the two persons (non-relatives) to whom you have given a Recommendation Form. Reference #1 Name Telephone Address Reference #2 Name Telephone ( ) Address CERTIFICATION I hereby affirm that the information provided on this form is accurate and complete to the best of my knowledge. I give to The Philadelphia Foundation permission to use my name and photograph in any print or electronic media. Signature Date Please review the checklist on page one of this application. By May 17, 2013, mail or deliver your completed application with attachments to: The Philadelphia Foundation Alumni HUP Nursing Scholarship 1234 Market Street, Suite 1800 Philadelphia, PA Additional college prep resources can be found at 01/2013

10 ALUMNI ASSOCIATION OF THE SCHOOL OF NURSING OF THE HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA NURSING SCHOLARSHIP SCHOLARSHIP RECOMMENDATION FORM Recommendation due to The Philadelphia Foundation by May 17, 2013 Applicant's Name Date Print Applicant's Signature NOTE: Signature grants permission to send information Check in the appropriate column your estimate of each trait listed: 1. In a work situation is the applicant: a. Resourceful b. Orderly c. Accurate d. Dependable e. Punctual f. Cooperative g. Thorough h. Adaptable i. Energetic 2. Is the applicant: a. Sensitive to the reactions of others b. Trustworthy c. Tolerant d. Tactful e. Well poised f. Self-controlled g. Receptive to criticism Consistently Moderately Seldom 1234 Market Street, Suite 1800, Philadelphia, PA p , f ,

11 Applicant's Name How long have you known the applicant? a. What do you consider the applicant's chief qualities? Strengths: Weaknesses: b. Does the applicant work well with people? Explain. c. Do you place full confidence in this applicant's integrity? Explain. d. Would you like this person to take care of you if you were ill? Explain 4. Would you endorse this applicant to receive a scholarship from the Alumni Association of the School of the Hospital of the University of Pennsylvania Nursing Scholarship Fund? Yes No If your answer is "no," please comment. Thank you for your help. Name Print Signature Position Address Telephone ( ) Date Please return this form by May 17, 2013 directly to: The Philadelphia Foundation Alumni-HUP Nursing Scholarship 1234 Market Street, Suite 1800 Philadelphia, PA /2013

12 ALUMNI ASSOCIATION OF THE SCHOOL OF NURSING OF THE HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA NURSING SCHOLARSHIP SCHOLARSHIP RECOMMENDATION FORM Recommendation due to The Philadelphia Foundation by May 17, 2013 Applicant's Name Date Print Applicant's Signature NOTE: Signature grants permission to send information Check in the appropriate column your estimate of each trait listed: 1. In a work situation is the applicant: a. Resourceful b. Orderly c. Accurate d. Dependable e. Punctual f. Cooperative g. Thorough h. Adaptable i. Energetic 2. Is the applicant: a. Sensitive to the reactions of others b. Trustworthy c. Tolerant d. Tactful e. Well poised f. Self-controlled g. Receptive to criticism Consistently Moderately Seldom 1234 Market Street, Suite 1800, Philadelphia, PA p , f ,

13 Applicant's Name How long have you known the applicant? a. What do you consider the applicant's chief qualities? Strengths: Weaknesses: b. Does the applicant work well with people? Explain. c. Do you place full confidence in this applicant's integrity? Explain. d. Would you like this person to take care of you if you were ill? Explain. 4. Would you endorse this applicant to receive a scholarship from the Alumni Association of the School of the Hospital of the University of Pennsylvania Nursing Scholarship Fund? Yes No If your answer is "no," please comment. Thank you for your help. Name Print Signature Position Address Telephone ( ) Date Please return this form by May 17, 2013 directly to: The Philadelphia Foundation Alumni-HUP Nursing Scholarship 1234 Market Street, Suite 1800 Philadelphia, PA /2013