College of Nursing

First Name *Middle InitialLast Name *Gender No Comment Female Male
Race No Comment African American Asian / Pacific Islander Hispanic (Native) American Indian (Caucasian) White Other
Email Address (USC Preferred) *Phone Number *Permanent Street Address *
City *CountyState *Postal Code *Estimated personal income per year ($)Estimated spouse income per year ($)Estimated parent(s) income per year ($)Estimated other income per yearOptional - Explain other incomeAre you currently receiving any other financial aid?Yes
No
Do you anticipate receiving any other financial aid?Yes
No
List any grants/loans/scholarships you anticipate receiving
List the total amount of aid you anticipate receiving in 2013What degree program will you be enrolled in Fall 2013? Bachelor of Science in Nursing (BSN) Master of Science in Nursing (MSN) Post-Master Certificate of Graduate Study in Advanced Practice Nursing Master of Science in Nursing/Master of Public Health Doctor of Nursing Practice (DNP) Doctor of Philosophy in Nursing Science (PhD)
Type of Student New Continuing Transfer
Level of Student (BSN only) N/A Incoming Freshman Lower Division (continuing Freshman or Sophomore) Applied for Upper Division Senior
Degree Emphasis (MSN only) N/A Acute Care Nurse Practitioner Adult Nurse Practitioner Community/Public Health Clinical Nurse Specialist Family Nurse Practitioner Pediatric Nurse Practitioner Psychiatric Mental Health Clinical Specialist Psychiatric Mental Health Practitioner/Specialist Women's Health Nurse Practitioner
Level of Preparation (DNP/PhD only) N/A Non-BSN prepared BSN prepared MSN prepared
Projected Graduation Semester Spring Summer Fall
Projected Graduation Year 2013 2014 2015 2016 2017 2018 2019 2020
Why you deserve to receive a scholarship? (100 words or less)
List an example of your innovation. (100 words max)
Are you currently an RN working in critical care? N/A YES NO
Are you a single parent?N/A
Yes
No
Applicant is a resident of N/A Union County, SC Kershaw County, SC Springfield County, SC
Applicant intends to work with N/A Substance abuse research (no experience) Substance abuse research (with experience) Alcohol abuse research (no experience) Alcohol abuse research (with experience) AIDS/HIV research (no experience) AIDS/HIV research (with experience) Oncology research (no experience) Oncology research (with experience)
Applicant was N/A born and raised in Richland County, SC born and raised in Lexington County, SC a resident of Carolina Children's Home a resident of Epworth Children's Home
Applicant is a member ofAny chapter of Sigma Tau International Honor SocietyAlpha Xi Chapter of Sigma Theta Tau International Honor SocietyAACNStudent Nurses Association (SNA)South Carolina Nurses Association - Any ChapterSouth Carolina Nurses Association - Central Midlands ChapterThe college can use my name/award amount in marketing materialsYes
No
My contact information can be released to my scholarship donorsYes
No
I will write a letter of appreciation to my award donor(s)Yes
No
I am willing to attend a function with award donorsYes
No