2025 AcruxKC Nursing Scholarship Payment Request Form

1. Basic Information

Provide the information requested below.
Scholarship Recipient's Full Name*

PrefixFirst NameMiddle Initial Last NameSuffix
Student ID # for Nursing School*
Email address for communication about my scholarship payment.
example@example.com

2. Payment Information

Provide the information requested below.
Name of College/University to which payment is to be sent.*
Choose One
Address to where payment is to be sent if different from your application.

Street Address or Attn: or Secondary Bldg.

Street Address Line 2

CityState / Province

Postal / Zip Code
Upload your fall 2025 invoice for tuition.*

Browse Files
This is not an estimate. It must show tuition actually charged. Cancelof
I have requested that my current official transcript be e-mailed to nursingscholarships@acruxkc.org. This transcript will be from your current school showing your current GPA including transfer grades through summer 2025.

YesNo
If you do not have need for the full amount or have any concern about your scholarship, please tell us what you believe your tuition need is or any additional information that we may need to know.

3. Acknowledgements

Please thoroughly read the statement below and check "yes" upon agreement. Do not forget to click 'Submit' upon completion.
I certify by my submission that I believe myself to be eligible to receive my fall 2025 AcruxKC nursing scholarship by meeting the following criteria:
- Having and maintaining a 3.0 GPA
- Being enrolled as a full-time student in an accredited college or university with a formal nursing program that leads to RN certification upon completion
- Have need for tuition assistance
I acknowledge and understand that should I not maintain a 3.0 GPA, remain at full-time student status in a formal nursing curriculum, or if I drop out of school, I will be obligated to reimburse all or part of the scholarship monies awarded.
YesNo
Printed Name

First NameLast Name
Should be Empty:

Nursing Scholarship Payment Request