Ebeid Neighborhood Promise Diversity in Nursing Scholarship Application

The Ebeid Neighborhood Promise (ENP) Diversity in Nursing Scholarship has been created to increase equitable access to healthcare-related fields, increase registered nurse (RN) diversity and representation, and reduce nursing staff shortages.

Incomplete applications, or applications missing the required documentation, will not be eligible for consideration. Students receiving an ENP Diversity in Nursing Scholarship, and graduating from a registered nursing program at one of the five colleges listed below, will be asked to sign a commitment to work for ProMedica for 3 years following nursing program graduation and board certification. Scholarship applications will be accepted on a rolling basis.

Please print clearly – see page 2 of this application for additional, required information. Demographics:

Applicant Name: Date of Birth: ______

Race/Ethnicity: Black Hispanic/Latinx Native American ___Asian Other (please print):______

Address: ___

City / State / Zip: ___

Phone Number: Alternate Phone No: ___

Email Address: ___

Diversity in Nursing Scholarship Application Requirements:

I graduated from high school, or will be graduating from high school in: ______(Year) Cumulative high school GPA: ______I graduated from the Ebeid Neighborhood Promise State Tested Nursing Assistant Program. YES NO NA If yes, please list the date of Ebeid STNA completion.

List your college choices, in order, from one of the following colleges: Hondros College of Nursing, Monroe Community College, Northwest State Community College, Owens Community College, and Terra State Community College. School 1: _ School 2: ____

Please list one of the above colleges, if you currently attend: ______I currently possess a GPA of 2.5 or higher. YES NO Please list your cumulative college GPA: ______*Note: for continued scholarship support through the Associate Degree in Registered Nursing, student must maintain GPA stated by college for acceptance to registered nursing program.

Applicant must reside in one of these ProMedica acute care service areas: : Allen, Auglaize, Branch (MI), Crawford, Coldwater, Defiance, Erie, Fulton, Hancock, Hardin, Henry, Hillsdale (MI), Huron, Lenawee (MI), Logan, Lucas, Mercer, Monroe (MI), Ottawa, Paulding, Putnam, Richland, Sandusky, Seneca, Van Wert, Williams, Wood or Wyandot. Do you reside in one of the above counties? YES NO What county do you reside in: ______

Please direct all questions to Lauryn Vargas via email, at lauryn.vargas@.org or phone, at 567-585-0564. 1

ENP Diversity in Nursing Scholarship - Application Instructions and Signature Page

1. This application is the first step in the Diversity in Nursing Scholarship process. a. There are several attachments to complete the application process to be eligible for consideration for this scholarship. Incomplete applications, including Required Documentation (below) will not be processed. Applications will be accepted on a rolling basis. b. If you are awarded a scholarship, the scholarship will utilize a “next dollar in” strategy, with funds made available after eligible financial aid is applied (excluding loans). 2. If you are awarded a Diversity in Nursing Scholarship, you will be asked to sign a commitment to work in a ProMedica facility for 36 months, following successful completion of the Associate Degree in Registered Nursing program and passing nursing board certification, in or Michigan. 3. A confirmation letter/email will be sent to the address/email provided. Please be accurate and print clearly. 4. Type and attach essays that answers the two questions below. The response to each of these questions must be, in total, a minimum of 250 words in length. a. Why do I want to pursue a career in healthcare and specifically nursing? b. What does the ProMedica Diversity in Nursing Scholarship opportunity mean to me? Required Documentation a. Completed ENP Diversity in Nursing Scholarship application, including signatures in the box below. b. Official High School Transcripts for this application may be obtained from high school counselors. c. Completed and submitted FASFA application, that may that be found at: https://studentaid.gov/h/apply-for-aid/fafsa d. Typed essay responses to the essay questions in #4 above. e. All students must sign and date the form in the box below. If you are not at least 18 years of age, your parent or legal guardian must ALSO sign and provide their contact information if different than yours. Submit the completed application and required documentation in one of the following ways: 1. Submit a scanned copy of this and required documents via email to [email protected] -Applications received by 10/1/2021 will be reviewed for scholarships offered in November, 2021. -Applications received by 3/1/2022 will be reviewed for scholarships offered in April, 2022. 2. Or, mail all written/hard copies to: ENP Diversity in Nursing Scholarship c/o Lauryn Vargas ProMedica Steamplant 100 Madison Ave., MSC-S29932 Toledo, Ohio 43604

My signature below indicates that I have read and understand the terms of this scholarship, and the information I have provided on this application and about enrollment in high school is true to the best of my knowledge. I understand that if I accept a Diversity in Nursing Scholarship, I will work at a ProMedica facility for 3 years following the successful completion of my nursing program. Student (Student must sign): Signature Date Parent/Guardian: (If Student is under 18 years of age) Signature Date Address: (Parent/Guardian’s address, If different than application) City / State / Zip: (Parent/Guardian’s address, If different than application)

Phone Number: Email Address: (Parent/Guardian phone number, If different than application) (If different than application)

Please direct all questions to Lauryn Vargas via email, at [email protected] or phone, at 567-585-0564. 2