The Carmen Bernal Compassionate Nursing Scholarship Application Form

GLIDE REVITALIZATION

P.O. Box 479, Glide, OR, 97443

scholarships@gliderev.com

www.gliderev.com

(541) 671-0866
'Carmen Bernal Compassionate Nursing Scholarship' Application Form

Application Deadline - May 1st, 2026
The ‘Carmen Bernal Compassionate Nursing Scholarship’ aims to support eager, patient-centered, and compassionate nursing students from rural Glide, Oregon. Carmen Bernal was a nurse in Douglas County for over 30 years, working in the hospital setting, rural home care settings, private practice, special education classrooms, and for the United States of America Veteran’s Administration. She also volunteered for hurricane relief efforts in the United States during her nursing career. Throughout her career, she demonstrated authentic, heartfelt compassion for her patients and adapted to the various environments to provide the best possible care. She was generous with her time and energy for both her patients and her colleagues. Despite an enduring battle with cancer, and true to her heart of service, Carmen continued to work as a nurse, providing for others the care that they deserved while facing their own health struggles.

This scholarship will support first-year nursing students who have graduated from Glide High School.

This scholarship is named the “Carmen Bernal Compassionate Nursing Scholarship” to honor the extraordinary compassionate values embodied by Carmen Bernal throughout her career.

Graduates of Glide High School who are planning to enter their first year of nursing school can apply for this scholarship.

This cohort can include any age group or educational level that is entering a 2-year or 4-year nursing program.
Read and follow the instructions carefully prior to submitting your application. All winners will be notified on or before the 1st of June 2026.
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.
Type a question
I. Personal Data

Tell us about yourself
Full Name*

First NameLast Name
Birthdate*

MonthDayYear
Mobile No*
Email *
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Optional Information

Information regarding gender, ethnic origin and race are optional. The information is requested for post-scholarship report generation only and in no way affects your selection for college scholarship awards. However, providing this information may increase your opportunities for scholarships where donors have asked that priority consideration be given to students meeting certain demographic criteria (such as minority status, parent's place of employment, area of study, etc.)
Gender

MaleFemale
Are you a US citizen?

YesNo
Please check your veteran status.

VeteranChild of a VeteranGrandchild of a VeteranSpouse of a VeteranNone of the Above
Please check your status at the time of application.

I will graduate in June 2030I will be an incoming college freshman graduating high school prior to Fall 2026I have attended college but have less than 32 college credit hoursI have attended college but have at least 32 or more college credit hoursI am a GED graduate with no college credit hoursI am a High School graduate with no college credit hours
Are you a first generation college student?

Yes, I am the first among my family to attend college.No, either one or both of my parents have attended college.
Major Area of Study
Please indicate what is your major area of study
What is your career objective?*

0/300
II. High School Information
Are you or will you be a June 2026 High School graduate?*

YesNo
High School Attended*
Year of High School Graduation or GED*
Most recent cumulative GPA*
Unofficial Transcripts

Finalized transcripts will be requested upon the interview stage.
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Activity Log: High School Activities (1) , Community Activities (2), Volunteer Work (3), Paid Work (4), *
Ex: #1 (Activity Name) - (Type) - (Start-End) - (Total Hours) - (Responsibilities)
Awards*
Ex: #1 (Award Name) - (Date Awarded)
III. University Information
University Name*
Enter the name of your current or expected University.
SAI#
Student Aid Index (SAI) - Found upon completion of the 2026-2027 FASFA (If you have not received your SAI put N/A)
IV. Essay
Applicants should submit a maximum 750-word essay answering the following questions.
- Why have you chosen to study nursing?
- What does compassionate nursing mean to you? Please provide 2-3 examples of what this might look like in practice.
- Please tell us about ways in which you have demonstrated a heart of service to others.
File Upload*

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V. Media Consent
I hereby grant consent for the use of my likeness in media streams, marketing materials, awardee recognition, and donor updates by Glide Revitalization, specifically in relation to the scholarship award. I understand that this may include, but is not limited to, photographs, videos, and other promotional content. I acknowledge that my consent is voluntary and that I will not receive compensation for such use. I also understand that once given, this consent is irrevocable, except where required by law. Please check the box below to indicate your consent.*

I consent to the use of my likeness as described above in relation to the scholarship award.I do not consent to the use of my likeness as described above in relation to the scholarship award.
VI. Applicant's E-Signature
By signing 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.
Signature*

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Glide Revitalization is committed to equal opportunity in employment and education. The nonprofit does not discriminate in any program or activity on the basis of race, color, religion, gender, age, national origin, disability, marital status, or any other protected class.
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'Carmen Bernal Compassionate Nursing Scholarship' Application Form

I. Personal Data

II. High School Information

III. University Information

IV. Essay

V. Media Consent

VI. Applicant's E-Signature