Florida Nurses Foundation

For blind review, please enter the last four numbers of your SS# in the box above.

FLORIDA NURSES FOUNDATION SCHOLARSHIP APPLICATION

Directions: Complete this form and save under SCHOLARAPP(last four numbers of your social security number. Example: SCHOLARAPP2345. Upload to the website in the appropriate slot.

A. PERSONAL INFORMATION (No Names Please)

Resident of______County in Florida for years. Date of Birth

If already licensed as an RN, Florida______please give license number: Other______Who depends on you for financial support? Explain (including ages of dependents): Dependent Relationship Age

Annual Income (Sources and Amounts): Source Amount Applicant Spouse Other Total Annual Income

B. PLANS FOR STUDY College or University of Attendance (REQUIRED):______County of College or University______

Beginning Date: Expected Graduation Date: Attendance: ______Part-time ______Full-time What nursing degree are you pursuing? ____Associate degree _____Master’s ____BSN (basic student; not yet licensed as RN) _____Doctorate Candidate (Please Circle): Y or N ____BSN (RN to BSN) What is your area of specialty or focus (if available):

GPA of last semester in nursing program:

FNF Scholarship Application 2012, updated 2015, 2016 1 C. EDUCATIONAL HISTORY SCHOOL CITY/STATE DATES DEGREE/ ATTENDED DIPLOMA

D. EXPERIENCE List employment for the past 5 years, beginning with the most recent EMPLOYER (CITY/STATE) MAJOR RESPONSIBILITIES DATES

E. FUNDING List any fellowships, scholarships or loan funds from other sources for which you have applied and/or received funds NAME SOURCE AMOUNT

F. PROFESSIONAL ACTIVITIES List professional organizations of which you are currently a member, any offices held, and extent of your involvement ORGANIZATION OFFICE INVOLVEMENT

List honor societies, civic organizations, or charitable/community groups of which you are currently a member and state type and extent of your involvement ORGANIZATION OFFICE INVOLVEMENT

List books, publications (e.g., articles or pamphlets) you have authored (attach if possible) Title Where Published Date

FNF Scholarship Application 2012, updated 2015, 2016 2 G. APPLICATION CHECKLIST Attach the following additional items to complete the application. ITEM SPECIFICATIONS Completed (Y/N) Statement indicating necessity for See below. Do not include your name on the statement of need. Do not scholarship exceed the page provided. Statement indicating goals and See below. Do not include your name on the statement of goals and potential for contributing to potential for contributing to nurses. Do not exceed the page provided. nursing Upload references from individuals who can address your academic aptitude, scholarship, and seriousness of purpose, and/or your clinical 2 letters of reference on FNF expertise. Form is on the website at floridanurse.org/grantupload. Be sure Reference forms that your name is not included on either of your reference forms. TWO references are required. Must be mailed directly from your school or in an envelope signed and Current OFFICIAL Transcript* sealed by a school official. Mail to Florida Nurses Foundation, P.O. Box 536985, Orlando, FL 32853-6985. Attach a separate copy of current driver’s license or voter registration card. If issued within the past year, you must provide other proof of residency. Validation of Florida residency Email to [email protected], fax to 407.896.9042 or send to Florida Nurses Foundation, P.O. Box 536985, Orlando, FL 32853. Emails are preferred.

Strict Deadline for application packet submission is June 1st.

Incomplete application packets and those uploaded after June 1 will not be reviewed. Completed applications include this application, as well as all items listed in Section G.

You are requested to make a copy of this application, signed face sheet, and references for your records. The original and all supporting documents are to become the property of the Florida Nurses Foundation and are not returnable. If additional space is necessary to answer any of our questions, please feel free to add pages (not including the Statement of Need or your Goals or Potential for Contribution).

It is the responsibility of the applicant to be sure that current official transcripts are delivered to the Florida Nurses Foundation by the deadline date of June 1st or your packet will be considered incomplete and ineligible for review.

Once you upload your application packet, you will receive a confirmation email of receipt from the Florida Nurses Foundation. Please keep this receipt for your records.

Notification of award recipients will begin approximately August 15th. Please do not call before August to see if you have received a Florida Nurses Foundation scholarship. Thank you for your consideration.

The APPLICATION DEADLINE IS JUNE 1st of the current application year.

Statement of Need

Please compose a statement not exceeding one single-spaced page, stating why it is necessary for you to receive an FNF scholarship. Do not include your name on this form.

If submitting separately from your application, please include the last four numbers of your

FNF Scholarship Application 2012, updated 2015, 2016 3 SS# here:

Goals and Potential for Contribution

Please compose a statement, not exceeding one single-spaced page, stating your goals and your assessment of your potential for making a contribution to nursing and society. Do not include your name on this form.

FNF Scholarship Application 2012, updated 2015, 2016 4 If submitting separately from your application, please include the last four numbers of your SS# here:

FNF Scholarship Application 2012, updated 2015, 2016 5