Zack and Rose Scholarship Fund Application Form

HOW TO WIN $1000 FOR YOUR NURSING PROGRAM

Application Deadline - March 15th (Fall Term), October 15 (Spring Term)
Read and follow the instructions carefully prior to submitting your application. All winners will be notified on or before the deadline.
Read and Understand the instructions.*

Yes, I have
If selected, you will be asked for documentation to support the data you provide. Likewise, all correspondence and award agreements will be generated from the personal information submitted below. So, please use proper spelling, capitalization and punctuation.
I. Personal Data:

Tell us about yourself
Full Name*

First NameLast Name
Birthdate:*

MonthDayYear
Mobile No. :*

Area CodePhone Number
E-mail :*
Where the confirmation will be send to
Gender:

MaleFemale
Are you a US citizen?

YesNo
What is your Career Objective:

0/300
II. High School Information:
High School Attended:
Year of High School Graduation or GED:
Most recent cumulative GPA:
High School activities, community activities, volunteer work, honors, offices held:
Current GPA:
School activities, honors, offices held, etc.:
VII. Essay
Your essay should be 300-500 words or 1 -2 pages APA format. You should address and title your essay: What it Takes to become a Nurse. Include any academic and non-academic accomplishments, personal characteristics, or experiences that make you uniquely worthy of scholarship consideration.
Essay:

0/500
VIII. Applicant's E-Signature
By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
E-Signature:*
Zack and Rose Scolarship fund is committed to equal opportunity in employment and education. We do not discriminate on the basis of race, color, religion, gender, age, national origin, disability, marital status, or any other protected class.
Should be Empty:

HOW TO WIN $1000 FOR YOUR NURSING PROGRAM

I. Personal Data:

II. High School Information:

VII. Essay

VIII. Applicant's E-Signature