Lindsey's Hope Application

Lindsey's Hope Nursing Scholarship Fund

Application for Award

Name *

Email Address *

example@example.com

(Street/Apartment Number/PO Box Number) *

(City/State/Zip) *

Home Phone

Area Code Phone Number

Work Phone

Area Code Phone Number

Cell Phone

Area Code Phone Number

Date of Birth *

Date

Gender *

Male Female

I am currently enrolled in the following accredited nursing program:

Name of School

(Street)

(City/State/Zip)

Phone

Area Code Phone Number

Year in Program

Anticipated Graduation Date

Date

What degree in Nursing will you receive?

I will be attending school

full-time part-time

Previous Education

	Institution	Location	Degree/Diploma	Completion Date
High School
College
Graduate School
Technical College

Volunteerism

	Church/Organization	Date of Involvement	Brief Description of Involvement
#1
#2
#3
#4
#5
#6
#7

Leadership Activities/Honors/Awards

Please list your most significant Leadership Activities, Honors and/or Awards

Workplace Experience

	Employer	Location	Position	Date Employed	Brief Description of Duties
1.
2.
3.
4.

Please write an essay not to exceed 1,200 words describing the following:

1. Your future goals in the field of nursing;

2. Your relationship with Jesus Christ;

3. Three personal strengths you have that will empower you to be extraordinary in your career and community;

4. Your interest in caring for persons with cancer. Please tell of any current or previous role you have had with someone who has cancer;

5. Any financial resources you currently have available to assist you with your academic endeavors. Please include any scholarships, financial aid, or other sources of assistance you may be receiving.

File Upload

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References

Please list the name of the person submitting a reference for each category below:

1. A teacher advisor, principal or director of the Nursing Department.

2. An employer, religious or community leader.

3. An individual, other than a family member or friend, who is knowledgeable with applicant's qualifications.

I certify, to the best of my knowledge, that the information provided to Lindsey's Hope Nursing Scholarship Fund is complete and true. Because of the importance of preserving the confidentiality of a reference, I, {name}, willingly waive my right of access to see this reference, knowing that this waiver is NOT required as a condition of award. My electronic signature (below) is to be considered the same as a handwritten signature in this case.

Signature *

Clear

Date *

Date

Deadline: Applications accepted in December and June for attendance in Spring and Fall semester, respectively.