WHEATON FRANCISCAN HEALTHCARE - ALL SAINTS FOUNDATION Application for the LeRoy Jerstad Nursing Scholarship Deadline Friday, January 1, 2016
Those seeking to begin or continue their education in the field of Nursing are eligible to apply for scholarships thanks to the generous support of the family of LeRoy Jerstad. WFH – All Saints Foundation is pleased to afford our associates this opportunity for financial support in accordance with our value of Development.
Scholarship Criteria*: 1. The applicant must be a WFH – All Saints Associate working a minimum of 20 hours per week at All Saints and must be in good standing. 2. Financial circumstances indicating need will be considered. 3. Two letters of reference from individuals other than family members must be submitted. One letter should be from a supervisor. 4. The scholarship recipient must provide proof of enrollment in an accredited nursing program 5. Must be employed and have active status for at least one year 6. Scholastic Performance 7. The recipient is expected to remain employed by Wheaton Franciscan Healthcare at least during the timeframe of the award, longer is preferred. 8. All applications must be in typed format, hand-written applications will not be considered. *Any exception to these criteria may be reviewed and considered by the Scholarship Committee.
Scholarship Process: 1. Scholarship applications available via TauNet, or call WFH- All Saints Foundation at 262.687.8654. 2. Please include two letters of recommendation with this application or have them mailed directly to the address below. One letter should be from a Supervisor, Manager or Director within WFH - All Saints, and the other a general character reference (not from a relative). 3. Scholarship applicants are required to provide college transcripts showing academic performance in recent college coursework. 4. The scholarship recipient may be asked to meet with the respective scholarship donor and will be asked to attend a scholarship awards reception, tentatively scheduled for March 2017. 5. Return completed applications to: WFH - All Saints Foundation, Attn: Scholarship Committee, 3805B Spring Street, Suite 220, Racine, WI 53405, faxed to 262-687-8655 or dropped off at the Human Resources office.
I have familiarized myself with the eligibility requirements established for the Wheaton Franciscan Healthcare – All Saints Foundation Scholarship Fund. I agree not to hold liable the scholarship committee as a whole, or it members, to any obligations, financial or otherwise, if it becomes necessary at any time to discontinue said scholarship. Scholarship checks will be mailed directly to the school. I understand that any monies awarded and not used for the purposes of this scholarship will be returned to Wheaton Franciscan Healthcare – All Saints Foundation. I authorize Wheaton Franciscan Healthcare – All Saints Foundation to release my information concerning my application and likeness for purposes of publicity if I am awarded the scholarship
Signature: Date:
Signature of parent or guardian if applicant is under age 18: Date Submitted:
Personal Information: Name: Mailing Address: Telephone: work home cell Start Date at WFH - All Saints: Present Occupation: : Manager at WFH – All Saints:
Education Information Name of college or vocational school you are attending or plan to attend: Name and location: Field of Study: Check One: Pre-Nursing: Clinicals: What type of nursing program are you enrolled in? ADN BSN MSN PhD Nursing/DNP Years attended: Date of anticipated graduation: Are you attending full-time or part-time? How many credits per semester? Cumulative GPA on 4.0 scale:
School Expenses List below the annual expenses at the school you will attend: Tuition and fees for next year $ Room and board for next year $ Books and supplies $ Miscellaneous and personal expenses $ Total expenses for next year $ Describe any special circumstances concerning your need for financial aid:
Please list any other scholarships or financial awards you anticipate receiving:
If you were not to receive this scholarship, how else would you fund your education?
LeRoy Jerstad Nursing Scholarship Employment/Community Service List present and former employers related to your career goals: Dates: Name and Address: Position:
List any community service activities you have been involved in: Organization: Activity:
Essay(s): Please include an essay, not to exceed one page typed (size 12 font), reflecting on any of the following topics –along with any circumstances or personal thoughts you wish the scholarship committee to consider when evaluating your application.
***Applicants applying for more than one scholarship must include a different essay with each application.
1. Why did you choose a career in nursing? 2. Have you ever needed to care for a loved one or friend? Please tell us about that experience and how it affected your career goals. 3. Tell us about a particularly challenging patient care or customer service experience you have had, why it was challenging and what did you learn? 4. Please explain how this education will assist you in advancing the nursing profession for yourself and others in the profession. 5. Why have you chosen to work at Wheaton Franciscan Healthcare-All Saints? And how will advancing your degree help the Mission, Vision, and Values of our organization? 6. A statement about your educational and career goals, both short-term and long-range.
For Scholarship Committee Use Only: o Signature o Transcript included o Two Letters of Reference included o Typed Application and Essay
LeRoy Jerstad Nursing Scholarship LeRoy Jerstad Nursing Scholarship