Scholarship Form - New Applicants

Have you previously received a Nurses Foundation of Racine, Inc. scholarship? If Yes, please see our separate form for re-applying for a Nurses Foundation of Racine, Inc. Scholarship.

Applicant Info

Name:

Date of application:

DOB:

Last 4 digits of SSN:

Address:

City:

State:

ZIP:

Phone:

Personal Email:

Member:

If Other, please specify:

How did you hear about this scholarship?

Educational Data

Name of college/university:

School Address:

City:

State:

ZIP:

How many credits have you completed?

How many credits do you anticipate taking next semester?

Present GPA:

Anticipated graduation date:

List any academic awards you have received:

List extracurricular school and community activities in which you participate:

Attach school transcript:

One file only.
2 MB limit.
Allowed types: pdf, doc, docx.

I will have my School Transcript mailed separately.

If mailing documents separately, use the following address:

Nurses Foundation of Racine, Inc.
P.O. Box 323
Caledonia, WI 53126

References

Make sure reference letters list the names, addresses, and phone numbers for whom recommendations were requested. It is your responsibility to contact them and inform them of the date references are due.

Nursing Instructor Reference

One file only.
2 MB limit.
Allowed types: txt, rtf, pdf, doc, docx.

I will have the Nursing Instructor Reference letter mailed separately.

Current or Recent Employer Reference

One file only.
2 MB limit.
Allowed types: txt, rtf, pdf, doc, docx.

I will have the Current or Recent Employer Reference letter mailed separately.

If mailing documents separately, use the following address:

Nurses Foundation of Racine, Inc.
P.O. Box 323
Caledonia, WI 53126

Financial Data

To enable the Scholarship Committee to select recipients, it is necessary to evaluate the financial need along with all other information provided. All information is treated as confidential by the committee.

What is the tuition for next semester?

How will you finance your education?

Financial aid:

Loans:

Grants:

Savings:

Income from work:

Assistance from parents:

Assistance from employer:

Scholarship(s):

Work Study:

Other:

Circumstances that impact your financial need:

Employment Data

List all employment held in the past 2 years, the dates, and reasons for leaving. Start with the most recent. Fields to list additional employers will be available after entering info for “Employer 1.”

Employer 1

Employer name

Dates employed

Reasons for leaving

Employer 2

Employer name

Dates employed

Reasons for leaving

Employer 3

Employer name

Dates employed

Reasons for leaving

Employer 4

Employer name

Dates employed

Reasons for leaving

Personal Essay

Explain why you chose nursing as a career goal and why you should receive this scholarship. Please keep submissions to around 500 words. (Required)

Applicant's Certification

I believe myself eligible for and hereby make application to receive one of the NFR scholarships. I certify all statements made in my application are complete and accurate. I understand that a committee selected by the NFR Board of Directors will select scholarship recipients and the decision will be final. I will be willing to participate in an interview if requested. I understand that should I be awarded a scholarship, it will be issued directly to my school and assigned as payment towards my nursing program. The scholarship can ONLY be applied toward tuition for the upcoming semester in the nursing program.
I understand if selected as a recipient of the NFR scholarship and FAIL TO ENROLL IN NURSING CLASSES FOR THE UPCOMING SEMESTER, the scholarship will be voided.
If selected as a recipient of an NFR scholarship, I authorize the use of my name, photo, and portions of my essay in a news release, NFR website, or NFR Facebook page.
Any financial and personal information will be kept confidential by the Nurses Foundation of Racine, Inc.

Electronic Signature (Full Name)

Date:

Mobile Mail

Scholarship Form - New Applicants