SLIPPERY ROCK UNIVERSITY DEPARTMENT OF NURSING SCHOLARSHIP APPLICATION FORM

Name: Address: Phone: Email: Advisor: Progress in program: Total # of credits completed and number of courses in progress Expected Date of Graduation: Overall QPA Major QPA

Review the enclosed table concerning scholarships available through the Department of Nursing and indicate the ONE scholarship that you are applying for. Donna Couillard Getreuer Scholarship Kay Hunt Scholarship Elinor Jeffrey Scholarship Leona Parascenzo Scholarship Rose Ricci Scholarship Kurt Martin Nelson Memorial Scholarship James Kellinger and George Gault Memorial Scholarship

Place a check mark before the following statements to indicate your financial needs.

I am receiving some support (grants, scholarships, reimbursement from employer), but I have additional costs that are not covered.

Besides a loan that I need to repay, I am receiving no support.

Other, please explain.

Explain in 500 words (one page) or less why you are a good candidate for the scholarship funds that you requested.

Statement of Agreement I verify that the information provided is true and that I will be registered for at least 3 credit hours in the semester in which the funds will be awarded. I agree to comply with the specific goals and spending stipulations for the scholarship funds received.

Name printed

Name signed ______Date Scholarships Awarded Through the Department of Nursing

Nursing Scholarship Application Award Criteria Use Due Dates Donna Couillard $1000 1. Nursing major Tuition support for March 19 Getreuer Scholarship 2. First preference to undergraduate nursing student with interest in students health care informatics Kay M. Hunt $500 1. Nursing major Tuition support for March 19 Nursing Scholarship 2. Minimum 3.0 GPA undergraduate nursing students Elinor Jeffrey $1000 1. Nursing major Tuition support for March 19 Scholarship 2. Junior level undergraduate nursing 3. Minimum 2.5 QPA students 4. Renewable for 1 year Dr. Leona Parascenzo $500 1. BSN completion Tuition support for March 19 Nursing Scholarship degree program undergraduate nursing 2. Minimum 3.0 QPA students 3. Non-renewable but previous awardees may reapply Rose Ricci Nursing $1000 1. Nursing major Tuition support for March 19 Scholarship undergraduate nursing students Kurt Martin Nelson $1000 1. Nursing major Tuition support for March 19 Memorial Scholarship undergraduate nursing students James Kellinger and $500 1. Nursing major Tuition support for March 19 George Gault undergraduate nursing Memorial Scholarship students

Selection criteria for all awards includes the following: 1. The applicant must have completed 6 nursing credits at Slippery Rock University by the end of Spring Term 2007. 2. The applicant must have no current incomplete or failing grades 3. The applicant must plan to enroll for at lease 3 credits in Fall 2007.

Selection criteria for the Donna Getreuer Scholarship includes a demonstrated interest in informatics. This interest can be demonstrated by (a) enrollment in the informatics minor, (b) having a plan of studies that includes all three informatics courses OR (b) currently employed in the field of nursing informatics. In addition the applicant should discuss their interest in informatics on the Scholarship Application Form.