2013 Scholarship Form

First Name *

Middle Name *

Last Name *

USC ID - This is a nine digit identifier starting with a letter. You can find it at https://my.sc.edu/apps/id/index. Otherwise enter "pending" if you do not have an assigned USC ID. *

Gender *

Race *

Email Address (USC Preferred) *

Phone Number *

Permanent Street Address *

Permanent City *

Permanent County *

Permanent State *

Permanent Zip Code *

Are you a U.S. Citizen? *

YesNoNo, but I possess a Visa permitting US residency

Are you a SC resident? *

YesNo

Are you a first-generation college student? *

YesNo

What is your military status? *

ActiveVeteranNot applicable

Estimated personal income per year *

Estimated spouse income per year

Estimated parent(s) income per year

Estimated other income per year

Optional - Explain other income

Are you currently receiving any other financial aid? *

YesNo

Do you anticipate receiving any other financial aid in 2024-2025? *

YesNo

List any grants/loans/scholarships you anticipate receiving. *

List the total amount of aid you anticipate receiving in 2024-2025. *

Have you submitted a Change of Campus Form from USC Lancaster to USC Columbia to begin upper division Fall 2024? *

YesNo

Are you a parent, legal guardian, foster parent, or adoptive parent? *

YesNo

Are you a single parent? *

YesNo

Applicant is a resident of *

Union County, SCKershaw County, SCSpringfield County, SCNot applicable

Applicant was *

born and raised in Richland County, SCborn and raised in Lexington County, SCa resident of Carolina Childrens HomeNot applicable

Applicant intends to work with *

Substance abuse research no experienceSubstance abuse research with experienceAlcohol abuse research no experienceAlcohol abuse research with experienceAIDS HIV research no experienceAIDS HIV research with experienceOncology research no experienceOncology research with experienceNot applicable

Applicant is a member of *

Any chapter of Sigma Tau International Honor SocietyAlpha Xi Chapter of Sigma Theta Tau International Honor SocietyAmerican Association of Critical Care NursesStudent Nurses Association (SNA)South Carolina Nurses Association - Any ChapterSouth Carolina Nurses Association Central Midlands ChapterNot applicable

Why do you deserve to receive a scholarship? (100 words or less) *

List an example of your innovation. (100 words or less)

What inspired your interest in the nursing field? (30 words or less) *

What are your area(s) of interest within the Nursing field? *

List two things you enjoy doing. *

What are your post-graduation plans/career goals? (30 words or less)

The college can use my name/award amount in marketing materials *

YesNo

My application information (i.e., email address, photo) can be released to my scholarship donors. *

YesNo

I am willing to attend an event with award donors. *

YesNo

Please upload a photo of yourself.

My CON

My CON

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