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Application for Admission—Tuition Assistance ProgramRuth Shaw Junior Board ScholarshipDate: ____________________A. Personal Information: to be completed by scholarship applicant (please print)First name-- Middle name(s) -- Last name:__________________________________________________________________________Address:Street: ____________________________________________________________________City:______________________________State:______________________________Zip code: _________________________Phone: ________________________ (home) _____________________________ (cell)Email:_______________________________Legal Local Permanent Residence: ____________________________________ City/StateB. Education: High School Attended: _______________________________________________City:______________________________State:______________________________Zip code: ________________Month/Year of Graduation______________________ Cumulative GPA (weighted/unweighted) __________*Legal local permanent residence is defined as permanent residence in the counties of Berks, Bucks, Chester, Delaware, Lancaster, Lehigh, Montgomery, and Philadelphia in Pennsylvania; Atlantic, Burlington, Camden, Cape May, Cumberland, Gloucester, Ocean and Salem in New Jersey; and New Castle and Sussex County in Delaware; and Cecil County in MarylandC. Undergraduate College(s) Attended (list in chronological order): Degree Granted or Campus/ Dates of Expected Current Institution Location/Site Attendance Major (w/date) GPA1. _____________ _____________ ____________ ________ _______________ _______2. _____________ _____________ ____________ ________ _______________ _______3. _____________ _____________ ____________ ________ _______________ _______4. _____________ _____________ ____________ ________ _______________ _______D. Extracurricular Activities List any extra-curricular activities you have engaged in during high and/or college or outside of school. State the positions and responsibilities which you held. Feel free to attachdates position held, honor/letter earned________________ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________E. Work or Volunteer Experience:Work or volunteer position/Dates/ length of Describe role andexperience experience responsibilities ___________________________ ____________ ________________________________________________________ ____________ _________________________________________________________ ____________ _________________________________________________________ ____________ _______________________________F. Other Requirements:On an additional sheet of paper, please write an essay outlining why you have chosen a career in nursing and your professional goals. The essay should be a minimum 3 paragraph essay.Along with application, please submit: Unofficial transcripts, resume, and two letters of recommendation. Your scholarship application and the above requested items should be sent:Option 1:Scanned and emailed to: Nursing applicants: Barbara Feeny at bfeeny@Allied Health applicants: Sheryl Mertz: at SMertz@ Please note: letters of recommendation delivered electronically must be submitted directly from the recommender. Electronic letter of recommendations will not be accepted if received from the applicant.orOption 2: Mailed to the following address:Christiana Care Health SystemAttention: Barbara Feeny - Suite 2E60BPatient Care Services-Development & Education4755 Ogletown-Stanton RoadNewark, DE 19713Please note: Letter of recommendations are to be mailed in a sealed envelope.I hereby certify that the information in this application is complete and correct to the best of my knowledge and belief.______________________________________________ _______________________________ Signature of Applicant DateRuth Shaw Junior Board Scholarship Recommendation LetterApplicant should complete the top portion and provide form & envelope to person completing recommendation portion.Applicant __________________________________Nursing School ____________________________Degree: ADNBSNBS (circle one)Anticipated Graduation Date _________Current Position (Employer or Volunteer) ______________________________________Name of Person completing the recommendation ____________________________Teacher/Counselor time frame worked with individual ___________Manager / Supervisor time frame worked with individual ___________Other (non-family member) time frame worked with individual ___________Instructions for person completing the recommendation: Please answer the questions below in regard to your experience with the above applicant. Your responses are personal and do not reflect the views of any company/organization to which you belong now or to which you have belonged in the past. 1: Strongly Disagree2: Disagree3: Undecided4: Agree5: Strongly AgreeN/A1. I would recommend this person for the Ruth Shaw Junior Board Scholarship.12345N/A2. This applicant displays a high level of professionalism in the work/school environment.12345N/A3. This applicant consistently performed duties in a reliable, responsible, and dependable manner (i.e. Report to work /volunteer position consistently and on time; consistently performed well; follows procedures).12345N/A4. This applicant consistently displays a positive attitude and is enthusiastic about nursing/ allied health.12345N/A5. This applicant easily communicates with colleagues, patients / customers, and others.12345N/A6. This candidate is able to manage time and accomplish responsibilities efficiently and effectively (i.e. Multi-task without experiencing an undue amount of stress).12345N/A7. This candidate is able to use knowledge, prior experiences, common sense, and critical thinking to make sound decisions.12345N/A8. This candidate demonstrates a caring and empathetic attitude towards patients/customers.12345N/A9. This candidate takes the initiative to seek out additional opportunities/experiences that will maximize development and performance.12345N/A10. This candidate excelled in his/her role and exceeded my expectations.12345N/A Please feel free to share additional comments as needed. Your answers will be kept confidential and not shared with the applicant. Please sign and seal in the provided envelope and return to the applicant or scan to:Nursing: Barbara Feeny at bfeeny@Allied Health applicants: Sheryl Mertz: at SMertz@Thank you.__________________________________________________________________ Name Date ................
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