Fillable Peg Edwards Nursing Scholarship Application (Rend Lake College)

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Peg Edwards Nursing Scholarship Application (Rend Lake College)

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Page 1 of 3
Peg Edwards Nursing Scholarship Application
Scholarship Year: 2019-2020
A. Demographic Information
Name:
Last_____________________________First____________________________Middle______________
Address:
Street & Number______________________________________________________________________
City, State & Zip Code__________________________________________________________________
Best Daytime Phone & Email:
Phone_______________________________ Email___________________________________________
Date of Birth, Gender & Citizenship:
Date of Birth________________________________ Male Female
Are you a U.S. citizen? Yes No
Have you been awarded any other financial assistance and/or scholarships to assist with the
upcoming school semester? Yes No
If yes, please list below and the amount awarded. (If additional space is needed please continue list on
the back of this page.)
1. _____________________________________________________
2. _____________________________________________________
3. _____________________________________________________
B. Schools Attended
1. HIGH SCHOOL: (Please skip section B1 if you are not a high school senior.)
Which high school are you attending and what is your anticipated graduation date?
High School__________________________________________ Graduation Date__________________
Page 2 of 3
Upon completion of high school, which nursing program do you plan to attend?
Nursing program______________________________________________________________________
Is this an Associate’s degree or Bachelor’s degree program? Associate’s Bachelor’s
If you are attending an Associate’s degree program, which nursing program do you plan to attend to
obtain your BSN? ____________________________________________________________________
2. NURSING PROGRAM:
Are you currently enrolled in a nursing program? Yes No
If yes, which nursing program are you currently enrolled and what is your anticipated graduation
date?
Nursing program______________________________Anticipated Graduation_____________________
If the nursing program in which you are currently enrolled is an Associate’s degree program, which
nursing program do you plan to attend to obtain your BSN?
Nursing program______________________________Anticipated Enrollment Date for BSN__________
If no, which nursing program do you plan on attending and what is your anticipated enrollment
date?
Nursing program______________________________Anticipated Enrollment Date_________________
If you plan to enroll in an Associate’s degree program, which nursing program do you plan to attend to
obtain your BSN? ____________________________________________________________________
C. Employment
Are you currently employed? Yes No
If yes, where are you employed? _________________________________________________________
What position do you hold?____________________How many hours per week do you work?________
How long have you worked in your current position? ___________________________
Page 3 of 3
D. Personal Statement
Your personal statement should be typed and attached to this application. Please address the following
categories:
- Brief introduction of yourself.
- Extracurricular activities, community involvement and/or volunteer activities.
- Past awards and/or personal achievements.
- Current and/or past positions, roles and/or experiences in which you have demonstrated
your leadership skills and abilities.
- Career goals.
- Why you believe you should be awarded the Peg Edwards Nursing Scholarship.
- Any other personal information you would like the Scholarship Selection Committee to
know about you.
E. Essay
Your essay should be typed and included with this application. Please answer the following question:
How do you feel you will make a positive contribution to the health care industry by working in
the nursing profession?
F. Statement of Accuracy
I hereby affirm that all the information provided by me in this application and its attachments is my
own work and is true and correct to the best of my knowledge and belief.
I hereby affirm that it is my intention to obtain at least a Bachelor’s degree in Nursing upon completion
of my post-secondary education at the institution(s) of my choice.
I also consent that my picture may be taken and used for any purpose deemed necessary to promote
the Peg Edwards Nursing Scholarship and/or SSM Health Illinois.
I hereby understand that if chosen as the Peg Edwards Nursing Scholarship winner, I must provide
evidence of enrollment/registration in an accredited nursing program before scholarship funds can be
awarded. If I have not been out of school for more than ten (10) years, I will be required to provide an
official transcript from the school I most recently attended and/or graduated.
Signature of scholarship applicant_____________________________________Date_______________
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Peg Edwards Nursing Scholarship Application (Rend Lake College)

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Completed 16 September 2020

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