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Anne Christensen Doyle Center for Engagement, Learning and Leadership
Allen College Board of Trustees Approves New Programs in Dental Hygiene and Public Health
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APPLICATION FOR SCHOLARSHIP ASSISTANCE FORM

APPLICATION FOR SCHOLARSHIP ASSISTANCE

(Please complete ALL information.)

  • Allen College is requesting this information in order to evaluate your application for scholarship assistance provided to Allen College through the Allen Foundation.
  • No application will be considered without response to all items on this application form and submission of all requested documents.
  • Your submission certifies that the information presented on this application is true and correct. Falsified information will result in disqualification for assistance.
  • Your submission of this application authorizes Allen College to share your application with potential donors and/or scholarship selection committee members.
  • Your submission of this application also authorizes Allen College to publicize your name in connection with any scholarship award you may receive.
  • In addition, your application also authorizes the Allen College Scholarship Selection Committee to check the references you have provided and to review High School and College transcripts, and allows access to financial aid information supplied by the federal government to the Financial Aid Office of Allen College.
  • It is your responsibility to verify Allen College has received your scholarship application and two references.  You can do this by checking "MyPulse".
  • Your scholarship application packet is not complete until Allen College has received your scholarship application, two scholarship references and FAFSA information.
*required info
Date 05/19/2013
Last Name *
First Name *
Middle Initial *
Maiden or Former Name(s)
   
E-Mail Address*
 
Current Mailing Address
Street *
City *
State *
Zip *
County *
Phone *
 
Permanent Mailing Address
Street
City
State
Zip
County
Phone
   
High School *
Year Graduated *
Hometown *
County *
   
Allen College program in which you will be enrolled for the upcoming year: *

Health Science
Nursing
Plan to enroll next summer: * Full time
Part Time
If part-time, number of hours:

Not planning to enroll summer
   
Plan to enroll next fall: * Full time
Part Time
If part-time, number of hours:

Not planning to enroll fall
   
Plan to enroll next spring: * Full time
Part Time
If part-time, number of hours:

Not planning to enroll spring
   
Expected Graduation Date From Allen College: *
Are you an Allen College alum? * Yes
No
If yes, what year did you graduate?
Are you related to an Allen College alum? * Yes
No
If yes, relative's name and how are you related?
   

Are you employed as a LPN or RN by Allen Health System? *

 Yes
No
   
Nursing Students only: Please indicate your area of interest - if any (eg. OB, oncology, emergency, etc.)
Have you already earned a post-secondary degree or will you have earned one by the time you start at Allen College?  (Are you seeking your second, third, etc. degree?) Yes No
Are you a single parent? Yes No
 
What other sources of financial assistance are available to you?
   
Extra-curricular Activities:
   
Scholastic Honors:
   
Other honors or recognition given:
   
Hobbies/Interests:
   
Work Experience:

PERSONAL ESSAY

Tell us about yourself and your interest in a healthcare career or advanced nursing. Also state why you feel you should receive this scholarship (address each of the following areas: financial need, career aspirations/goals, community service, etc.) Please include if you have any interest in a specialty area as some scholarships are for specific specialties. Your essay will be carefully examined and may be selected as it best matches the scholarship donor's background and criteria.


Statement about yourself and interest in nursing/health sciences (include if you have an interest in specialty area):
   
Financial Need (describe special financial circumstances):
   
Career Aspirations/Goals:
   
Community Service/Civic Activities (list/describe community service/civic activities in your recent past):
   
Other Comments/Information:
  Your scholarship application packet is not complete until Allen College has received your scholarship application, two scholarship references and FAFSA information. It is your responsibility to verify the receipt of your scholarship application and two references. You can do this by checking "MyPulse".

Please read and check off the application checklist below.
Application Checklist
All information on application form completed. Please allow 5 working days for your scholarship record to update on "MyPulse.".
Submit two references. Click here to access the printable version of this form. Please check "MyPulse" to make sure your scholarship references have been received prior to the scholarship application deadline.
Submit FAFSA application by March 1
I understand that if I am awarded an Allen College institutional scholarship, I must commit to attend the Allen College Scholarship reception/banquet in the fall.  If I fail to attend, I may lose any Allen College Institutional Scholarships awarded.
Signature

By submitting this information, I certify that the answers and information set out above are true, accurate and complete to the best of my knowledge. I acknowledge that if any answer or information is not true, accurate or complete, I may not be considered for an Allen College Scholarship

Applicant/Electronic Signature (type name)*

05/19/2013
Verification code:

(319) 226-2000 | Address
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