KALAMAZOO VALLEY COMMUNITY COLLEGE

Michigan Board of Nursing

Scholarship Application

Award Information: The Department of Community Health has established a nursing scholarship to promote associate degree and bachelor degree registered nursing education in Michigan. KVCC will be awarding a total of $4,000.00 in nursing scholarships, based on need or academic achievement. Recipients will be notified by August 18, 2006.

Rules for the Scholarship:

1. Recipients of the scholarship will be required to meet the following:

· Resident of the State of Michigan;

· Intend to practice within the State of Michigan in an underserved area, with an under served population, or in a health professional shortage area;

· Not in receipt of a full scholarship from another source; and

· Enrolled in or admitted to Level II of the KVCC nursing program.

2. Application for the scholarship must be thoroughly completed utilizing the attached forms or by going to the nursing web site. Applications must be typed and responses limited to the space provided.

3. Applicants must also complete Appendix A – Nursing Scholarship Application. KVCC will need to send this completed form to the Michigan Department of Community Health, Office of the Chief Nurse Executive for those applicants awarded a scholarship.

4. If your application is based on need, you must have a current FAFSA (Free Application for Federal Student Aid) on file with the KVCC Financial Aid Office.

5. Scholarship awards are to be applied first to the cost of tuition, fees, and books associated with the program. Any remaining money from the award will be provided to the recipient in the form of a check.

6. The Michigan Department of Community Health, Office of the Chief Nurse Executive will be notified of each recipient of the scholarship award and of the recipient’s completion of the KVCC nursing program.

7. All applications must be received in the Financial Aid Office by July 7, 2006.

8. Scholarships are awarded to recipients on a one-time only basis.

KALAMAZOO VALLEY COMMUNITY COLLEGE

Michigan Board of Nursing Scholarship Application

Date:

Name:

Address:

City, State, Zip Code:

Phone:

Social Security Number:

Circle At Least One: NEED-BASED ACADEMIC-BASED

Office Use Only:

Current GPA:

Credit Hours Completed:

FAFSA on File:

Remaining Financial Need:

Provide 2 personal letters of endorsement (letters from nursing faculty, clinical instructors, or family members are not permitted). A letter of endorsement is a letter supporting you for consideration to receive a nursing scholarship.

All applicants must submit a response to each of the following six (6) statements.

For the academic-based application only, responses will be evaluated using the following criteria:

· Responses are presented in a logical and concise fashion.

· Responses are grammatically correct and free of spelling errors.

1. What is the role of a Registered Nurse in health care?

2. Describe the issues you may face as a Registered Nurse of a medically under served area or under served population.

3. List any volunteer activities (e.g., community, church, family, school, etc.). Include the dates in which you were involved in these activities.*

4. List any awards received (e.g., achievement, leadership, service, etc.). Include the year received.*

*Activities and awards do not affect your eligibility to apply for this scholarship.

TO BE READ AND AFFIRMED BY THE APPLICANT:

I hereby certify that the information contained in this application is correct to the best of my knowledge.

Applicant Signature Date

Appendix A

MICHIGAN BOARD OF NURSING SCHOLARSHIP APPLICATION

I, , understand that I have been nominated for the Nursing Scholarship and I affirm my wish to be considered. I acknowledge and will abide by the conditions and requirements contained herein to merit the awarding of this scholarship.

I affirm that the information contained herein is true and accurate to the best of my knowledge and belief.

Date: Signature:

Legal name in full Sex: M F

(Type) Last Name First Name MI

Race:

(Optional)

Permanent residence

Number, Street, and Apartment Number

City State ZIP

Employment Address

(If applicable) Institution/Facility Street

City State ZIP

Phone Day: Evening: E-mail:

Present position/title:

(If applicable)

Name of nominating institution: Kalamazoo Valley Community College

Current cumulative GPA on a scale of

Undergraduate major

Number of credits earned to date Number for degree

I agree to work in the following underserved county

(For RN the entire state is considered underserved)

Kalamazoo Valley Community College
Texas Township Campus - 6767 West O Avenue, PO Box 4070, Kalamazoo, MI 49003-4070 - 269-488-4400
Arcadia Commons Campus - 202 North Rose Street, Kalamazoo, MI 49007 - 269-373-7800