THE 40 & 8 VOITURE LOCALE #1098

NURSES TRAINING TRUST FUND

FORWARD TO: Mr. Charles Palmer, Correspondent /Scholarship Committee 40/8,1352 S. Century Circle#103, Wasilla, AK 99654 / cell – (907) 242-1530

NOTE: This form is for use by student residents of the Municipality of Anchorage, pursuing a bachelor degree in nursing and who have successfully completed their 1st year of study. They must be intent on remaining in the South Central vicinity upon graduation. Applicants who are military veterans, or family members of military veterans are encouraged to apply.

INSTRUCTIONS

  1. Read carefully, the Rules of the Voiture Locale #1098 Nurses Training Committee to be sure that your application meets all requirements.
  2. Type or print all information clearly.
  3. Do not omit any information. If an item is not applicable, write“N/A.”
  4. Applications submitted without all the necessary signatures will not be processed and will be returned for completion.
  5. In item 19,you are asked for a release for publicity purposes. If you agree, the Voiture Locale #1098 Nurses Training Committee will use only your name and photograph to publicize its program. All information on this application will be kept strictly confidential.

NOTICE: TO BE ELIGIBLE FOR THE SCHOLARSHIP YOU MUST BE CONSIDERED A FULL-TIME STUDENT BY THE EDUCATIONAL INSTITUTION.

APPLICATION INFORMATION

1. Name______------

(First) (Middle) (Last)

2. Address______

(Number & Street)

3. Date of Birth______

4. Student ID No.______

5.Marital Status__Single__Married__Divorced__Separated

6. Home Telephone (_____)-______-______------

Photo above

7. List below all dependents of applicant:

NAMEAGE RELATIONSHIP

______

______

______

______

8. Parents or Guardian’s Name______

9. Parents or Guardian’s Address:

______

(Number and Street) (City)(State)(Zip Code)

10. Parents or Guardian’s Telephone No. ( ) - ______-______

11. List all dependents of parents (do not list parents)

NAMEAGE RELATIONSHIP

______

______

______

______

EDUCATIONAL INFORMATION

High School/Dates Degree

12. CollegeAddress Attended Diploma

______

______

______

13. Attach a transcript of your current record at nursing school.

14. Have you applied or do you intend to apply for other scholarships, fellowships?

______Yes ______No

If “Yes”, explain:______

______

15. On separate blank paper, write a detailed, one-pageaccount of your plans for your future professional objectives. Include your reasons for choosing a nursing career, the results of any special tests, and other pertinent information you wish the Committee to have that is not included elsewhere on this form. Please attach to this application.

FINANCIAL INFORMATION

16. Annual Income (Applicant) $______(Parents or Guardian and Spouse, combined) $______

17. Who suggested you apply to this trust fund for aid?

NAMEADDRESS

______

18. List three persons in your community who know you.

NAMES PHONE ADDRESS

______

______

______

19. If you are granted aid, will you permit the Nurses Training Committee to use your name and photograph (only) to publicize its program (see instructions,

page 1)?

Yes______No______

APPLICANT’S STATEMENT

In the event I am granted aid, I hereby certify that:

(1)I am in need of the aid in order to continue my education.

(2)I am, or will be, properly enrolled as defined by the Office of the Registrar.

(3)I will use the proceeds of the aid only for the payment of tuition and required fees, board and room, or similar living expenses, and for other school-related expenses.

(4)I agree to notify the 40/8 Voiture #1098 Nurses Training Committee at its principal office within 10 days if I drop out of the Nurses Education program for which aid was granted.

(5)I will forward copies of my grades at mid-term and at the end of the academic year to the 40/8 Voiture #1098 Nurses Training Committee at its principal office.

(6)I hereby acknowledge that the information provided herein is true and correct.

DATE:______

APPLICANT’S SIGNATURE______

The 40/8, a division of the American Legion, is a national organization made up of legionnaire over-achievers so chosen by their comrades and presented for membership to the local 40/8 Voiture. The American Legion is a national community service organization made up of veterans of the US armed forces. The name, 40/8, comes from the narrow track French railroad box cars used during World War I, which would hold either 40 men or 8 horses.