Klamath Falls Elks Nurse’s Education Scholarship

Klamath Falls Elks Nurse’s Education Fund at Sky Lakes Medical Center Scholarship Application

This scholarship is restricted to nursing education in an amount not to exceed the tuition assessed by Oregon State System of Higher Education Institutions. Priority is given to nursing students attending OHSU School of Nursing at OIT and to graduates of a Klamath County or Klamath Basin high school in any school, public or private, within the County or Basin. Students attending another accredited school of nursing in the State of Oregon may apply. The awarding committee will consider only applicants with a cumulative G.P.A. of at least 2.00 or equivalent.

Copies of this application blank may be procured by sending a stamped self-addressed envelope to:

Sky Lakes Medical Center Foundation

2865 Daggett Avenue

Klamath Falls, Oregon 97601

A.  Instructions: Mail or deliver the following items by midnight Friday, February 21, 2014, to:

Sky Lakes Medical Center Foundation

2865 Daggett Avenue

Klamath Falls, Oregon 97601

1.  This completed application form.

2.  An official transcript of your school or college record to date.

3.  A 300-500 word essay about yourself, including hobbies, plans and aspirations, factors which have favorably or adversely influenced your life, health, reason for desiring to attend the school or college you have chosen, and any other information about yourself which you think pertinent. Please type if possible.

B.  Three letters of recommendation from individuals who know you well. These may include a businessman or businesswoman, minister, professor under whom you have taken courses this year, or present employer. Please ask each of them also to fill in a copy of the reference form included with this application. (Three attached.)

C.  Mail all items in a single packet. The letters of recommendation should be in sealed envelopes so that they may be confidential.

1.  Name of Applicant

Last First Middle

2.  Date of Birth

Month Year

3.  If Married, Spouse’s Name

Occupation

If applicable, Children’s Names and Ages

4.  Applicant’s Current School

School Address

5.  Applicant’s Home Address

6.  Applicant’s Telephone Number

7.  Name of Father/Guardian

Occupation

8.  Name of Mother/Guardian

Occupation

9.  Number of children in family older than you? Younger than you?

10. List High Schools and Colleges you have attended:

School or College Location Dates Attended

11. Name of School or College you plan to attend next year

12. If you are transferring from your present school or college, please state reason

13. From which school or college do you plan to graduate?

14. List special honors, prizes or scholarships you have received for academic work during your last two years in high school and in college (use additional pages if needed):

15. Describe your work experience (part-time, full-time and vacation periods.) List employers and duration of employment (use additional pages if needed):

Employer Job Title/Description Dates Worked

16. Why are you interested in becoming a nurse? (Use additional pages if needed.)

17. List activities in which you have taken part during the last two years of high school or in college. Mention any special recognition received or offices held. Use additional pages if needed.

High School

College

Community or Church Organizations

18. List approximate dollar amounts for your college expenses for current year and for next year to be supplied by:

Current Year Next Year

1.  Parents/Spouse

2.  Scholarships

3.  Loans

4.  Savings during Vacations

5.  Earnings during school

6.  Other sources (specify)

19. For what other scholarships are you applying?

20. Estimate total amount of additional cash needed for next year in college.

21. Other comments

22. Date

23. Signature of Applicant

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