Future of Nursing Scholarship

"*" indicates required fields

1Eligibility Confirmation

2Application

Eligibility: Please select only ONE of the criteria below that apply to you.*

You must meet one of the following criteria to be eligible to apply for the Future of Nursing scholarship. Your answer to this question will not be reviewed by the selection committee, but will be used only to confirm eligibility.

I live in Hillsdale County.

I attend school in Hillsdale County.

I am the child of a current Hillsdale Hospital employee.

I am the grandchild of a current Hillsdale Hospital employee.

Zip Code*

School Name*

Name of Hillsdale Hospital Employee*

Student Information

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone*

Email*

Educational Information

High School*

High School Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

High School Phone*

Counselor's Name*

First Last

Counselor's Phone*

Current Grade Level*

Freshman

Sophomore

Junior

Senior

GPA (3.0 or higher)*

ACT Score

SAT Score

Class Rank*

Transcript(s)*

Drop files here or

Max. file size: 200 MB.

College/University Information

List top three colleges you have applied to, in order of preference.

First Choice College Name*

First choice college application accepted or pending?*

Accepted

Pending

Second Choice College Name

Second choice college application accepted or pending?

Accepted

Pending

Third Choice College Name

Third choice college application accepted or pending?

Accepted

Pending

Proposed Area of Study*

References

List the two instructors or school administrators who provided written letters of recommendation and upload a PDF or scanned copy of that letter.

Reference #1 Name*

First Last

Reference #1 Phone*

Reference #1 Email*

Reference #1 Letter of Recommendation*

Max. file size: 200 MB.

Reference #2 Name*

First Last

Reference #2 Phone*

Reference #2 Email*

Reference #2 Letter of Recommendation*

Max. file size: 200 MB.

School & Community Activities

Please list extracurricular, community, and religious activities you have participated in during the past 4 years. Please list the activities in order of importance to you.

On separate lines, list each activity plus the years participating and any leadership positions, awards or recognition for that activity.*

Academic Honors

Please list academic honors you have received during high school.

On a separate line, list honors awards received along with the year of high school during which you received it.*

Family Information

Fill out this section only if your parent(s)/guardian(s) claim you as a dependent on their tax return.

Father's Name

First Last

Father's Occupation

Father's Employer

Mother's Name

First Last

Mother's Occupation

Mother's Employer

How many older siblings do you have?

How many younger siblings do you have?

How many members of your household, including parents/guardians, are in college? Please explain.

Financial Information

Have you submitted the Free Application for Federal Student Aid (FAFSA)?*

Yes

On what date was your FAFSA application submitted?

MM slash DD slash YYYY

Expected Family Contribution (EFC), from FAFSA Student Aid Report (SAR)

Total Household Income (adjusted gross income from tax return)

Below $20,000

$20,000 to $29,999

$30,000 to $39,999

$40,000 to $49,999

$50,000 to $59,999

$60,000 to $69,999

Above $70,000

Tuition*

Financing your intended educational program (Please give costs for your first-choice college.)

Financial Aid from Other Sources (scholarships, grants, loans, etc.)*

Financing your intended educational program (Please give costs for your first-choice college.)

Projected Total Cost of First Year*

Financing your intended educational program (Please give costs for your first-choice college.)

Remaining Need (subtract other financial aid from tuition)*

Financing your intended educational program (Please give costs for your first-choice college.)

Please describe any unusual financial circumstances in your household.

Essays: Educational & Career Goals

Why Healthcare Essay*

Please indicate your educational goals and why you want to pursue a career in healthcare. Please provide an essay of 3500 characters or less, including spaces, in the field below.

Why Hillsdale Hospital Essay*

Please indicate why this opportunity is important to you and why you would want to work at Hillsdale Hospital. Please provide an essay of 3500 characters or less, including spaces, in the field below.

Acknowledgement*

I understand that application for educational loan assistance does not guarantee acceptance into the Hillsdale Hospital Educational Assistance program. All applications will be considered on an individual basis and the educational program being pursued. Financial assistance will be based on fees and charges of local accredited programs within the State of Michigan. Only tuition will be covered by this scholarship. The completion of any program does not guarantee employment. I voluntarily give Hillsdale Hospital the right to make a thorough investigation of my past activities. I understand that if I have given any false information on this application or if I have omitted any material facts, I may be disqualified from the program, or if accepted, I may be discontinued from the program upon any misrepresentation or omission. If accepted into the Educational Loan Assistance Program, I agree to execute a Loan Agreement, which will set forth my loan repayment obligation as well as my right to forgiveness of that obligation.

I understand and agree with the above statements and to the best of my knowledge provided complete and accurate information.

Signature*

Please enter your name here to serve as your digital signature.

Today's Date*

MM slash DD slash YYYY