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2014-2015 NURSING SCHOLARSHIPS COVER SHEET
(Please attach cover sheet to the front of your CHP Departmental Scholarship/Fellowship
Application indicating which scholarship(s) you want to be considered for)
TO APPLY:
1. Read criteria on pages 4-6 for individual scholarships carefully. On the list below, check the scholarships for
which you are eligible and for which you wish to be considered.
2. Complete the College of Health Professions 2014-2015 scholarship application form (pages 2-3). Directions
for completing application are on page 2. Complete the financial aid section if you wish to be considered for
scholarships that have financial need as criteria for selecting the recipient(s). Also, the FAFSA, federal financial
aid form, should be on file in the WSU Office of Financial Aid by April 1, 2014. The CHP Departmental
Scholarship/Fellowship Application is required to apply for both College of Health Professions general
scholarships AND for specific endowed nursing scholarships.
3. A reference letter(s) is required for ALL nursing scholarships and must be included to be considered
for a scholarship(s). Individual scholarship criteria indicate who should provide the letter(s). Letters can
accompany application or can be mailed to the Nursing Department directly from the individual writing the letter.
See page 2 for additional requirements regarding goal statement and activities chart (#4 and #5).
4. Return completed materials to Undergraduate Nursing Office, Room 541 Ahlberg Hall, WSU School of
Nursing, Wichita, KS 67260-0041 by March 1, 2014.
Detach here. Please staple to the front of your
CHP departmental scholarship application and materials.
----------------------------------------------------------------------NURSING SCHOLARSHIPS for 2014-2015
Name ____________________________________
Please circle which program you are admitted into: BSN
Student ID Number____________________________
Accelerated BSN
RN to BSN
Masters
DNP
Please consider me for the following scholarship(s): (requirements for scholarships on pages 5-7)
For Undergraduates:
____Alley, Gladys H. Scholarship in Nursing
____Bolton, Orville and Margaret
____Brookhouser, Vicky S. Scholarship
____Fitzpatrick, Hermina Endowed Scholarship
____Halstead, Helen Scholarship
____Henderson Scholarship
____Huntington, Patricia J. McNamara
____Johnson Scholarship
____Lantz, Mildred L. Scholarship in Nursing
____Piper, Ola Osborn Scholarship
____Riordan, Dr. Janice-Endowed Scholarship
____Sanchez-Gietzen Scholarship
____Shideler, Charles & Betty-Scholarship
____Via Christi Endowed Scholarship
____Webb, J Eleanor Endowed Scholarship
____Wesley Foundation Nursing Scholarship
____Whittaker, Regina L. Behring Endowed
Letter(s) of recommendation is being written by:
Applicable Only to Students Enrolled in the
Accelerated BSN Program:
____Anderson, Bob & Darlene Accelerated
Nursing Scholarship
For Graduate and Undergraduates:
____Kruger, Dr. Susan Scholarship/Fellowship
____Miles, Gene & Marie Endowed
Scholarship/Fellowship
____Rose, Paul Christopher & John Timothy
Scholarship/Fellowship
____ Sterling, George E. & Blanche
Scholarship
____Wesley Women’s Assoc. Maternal-Child
Nursing Scholarship/Fellowship
____Zona Richardson Scholarship/Fellowship
Graduate Nursing Fellowships:
____Anderson, Robert & Darlene Fellowship
____Rose, Ray Memorial Endowed Nursing
Fellowship
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Students Admitted and Continuing in
Professional Programs 2014-2015
College of Health Professions Departmental Scholarship/Fellowship Application
Application Instructions:
1. FOR ALL SCHOLARSHIPS/FELLOWSHIPS, you must be admitted to a College of Health
Professions professional program AND have a minimum cumulative GPA of 3.0. An interview
may be requested as part of the selection process.
2. Complete the financial aid information section of the application if you wish to be considered for needbased scholarships/fellowships and file a Free Application for Federal Student Aid (FAFSA).
www.fafsa.ed.gov.
3. Attach a TYPED one page personal statement limited to 500 words. You may use your statement to
highlight your special interests, talents, goals or unique experiences. Please include long range goals. The
personal statement allows you to provide additional information for consideration by the
scholarship/fellowship committee.
4. Attach an activities chart including your academic, leadership, extracurricular, campus, community
service, and work experiences. With each activity, provide the dates you were involved, time commitments
and any leadership roles you had. (Please see example of chart).
5. Return this application to your departmental office in Ahlberg Hall. Keep a copy of this application
for your records. This application is for awards from Dental Hygiene, Health Science, Health Service
Management and Community Development, Medical Technology, Nursing, Physical Therapy, and
Physician Assistant.
6. Application deadline is March 1, 2014 for Nursing.
STUDENT DATA
Legal Name___________________________________________________________________________
Last
First
Middle
Maiden or other
WSU ID: _________________________
Date of birth (mm/dd/yyyy): _____________________
Mailing Address__________________________________________ Apartment # _________________
City ___________________ State ________________ Zip _____________
Phone (
) ____________ _____ Cell Phone (
WSU Email Address: _____________________
)
Alternate Email Address: ______________________
Academic Major: _______________________ Anticipated Graduation (semester/year): _____________
Expected enrollment (# of credit hours) at WSU during:
Fall 2014
Are you a U.S. citizen or Permanent Resident? Yes
No
Are you currently employed?
Yes
No
_____
Spring 2015
_______
Hours per week _________
CRITERIA QUESTIONS: The following questions are used to determine your eligibility for specific
scholarships/fellowships. (This is not a full list of CHP scholarships/fellowships nor are these the only criteria
used to determine the awards.)
Sherr Scholarship/Fellowship (circle your classification): undergraduate
graduate
Campuzano Scholarship: Are you a first or second generation immigrant to the USA with permanent
residency or US citizenship? Yes
No
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Benn Memorial Scholarship/Fellowship only:
Are you a Derby High School graduate? Yes
No
O’Blenness Scholarship/Fellowship:
Gender: Female Male
FINANCIAL AID INFORMATION (optional): All financial information will be kept confidential. This section
is optional but must be completed along with the FAFSA if you wish to be considered for need-based
scholarships.
STUDENT:
PARENT(S) or GUARDIAN(S): (Dependent students only)
__________
Estimated yearly gross income
__________
Estimated yearly gross income
__________
Total number of dependents (not
including yourself, spouse/partner)
__________
Total number of dependents (not
including yourself, spouse/partner)
__________
Number of dependents who will be
full-time college students in 2014-2015 AY
__________
Number of dependents who will be
full-time college students in 2014-2015 AY
Yes No
Has there been a significant change in your
financial status in the past year? If yes,
please include a “Financial Statement” with
your application. Instructions below.
Yes No
Has there been a significant change in your
financial status in the past year? If yes,
please include a “Financial Statement” with
your application. Instructions below.
FINANCIAL STATEMENT: If you feel the financial information entered above and on your FAFSA does
not fully reflect your current economic situation, please complete a financial statement and include it with your
application. You may include information regarding you and your family’s financial status that supports your
need for scholarships.
Student Certification and Signature:
I certify all answers I have given in this application are accurate to the best of my knowledge. I understand
failing to disclose or falsifying information could result in my dismissal from Wichita State University and
making a false writing is a felony under Kansas law (K.S.A. 21-3711). Social security number and student
status data may be provided to other state agencies for use in fraudulent or illegal claims against state monies.
I grant permission to obtain information about my grade point average, enrollment status, and financial status
to evaluate my candidacy for scholarship awards. I understand this information will be kept confidential and
will be available only to the scholarship committee having a need to know for the purpose of scholarship
determination.
If I am awarded a scholarship, I authorize the University to publish my name as a scholarship recipient. If
offered an award, you will be expected to attend the College of Health Professions' annual
scholarship/fellowship reception for the opportunity to thank your donors in person. You are also
expected to send a “thank you” letter to your donor.
Signature of Applicant
Date
Notice of Nondiscrimination:
Wichita State University does not discriminate in its programs and activities on the basis of race, religion,
color, national origin, gender, marital status, sexual orientation, age, status as a Vietnam-era veteran or
disability. Any person having inquiries concerning this may contact the Office of Equal Employment
Opportunity, Wichita State University, 1845 Fairmount, Wichita, KS 67260-1045, (316)978-3001.
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This is the recommended format for an activities chart:
Scholarship Requirements - School of Nursing
Alley, Gladys H. Scholarship in Nursing. Student must be enrolled full-time in the Nursing
Program. No recipient will be excluded from consideration based on race, religion, color,
national origin, gender, age, sexual orientation, marital status, status as a veteran or disability.
Recipients must maintain a 3.4 grade point average. Award will be made without regard to
financial need. The Scholarship maybe renewed based upon satisfactory academic progress.
Bolton, Orville and Margaret. Full or part time. Minimum GPA of 3.0. Renewed annually for
maximum of 2 years with satisfactory performance. Financial need not required.
Bob & Darlene Andersen Accelerated Scholarship. Student must be enrolled full-time in the
Accelerated Nursing Program. Award will be made without regard to financial need. The
Scholarship may be renewed based on satisfactory academic progress.
Brookhouser, Vicky S. Scholarship. Enrolled full or part time in the CHP School of Nursing.
Consideration given to a non-traditional female nursing student with children. Minimum GPA of
3.0. Financial need considered. A 1-2 page biography to be reviewed by Ms. Koehn or her
designee outlining: what motivated the applicant to return to school and what can be identified as
a special life circumstance which motivates the student for this scholarship. Renewed
automatically with satisfactory performance.
Fitzpatrick, Hermina End. Scholarship. Full or part time enrollment in the nursing program.
Minimum GPA to meet School of Nursing criteria. Financial need not a consideration.
Dr. Helen Halstead Nursing Scholarship. Criteria for the scholarship include a minimum GPA
of 3.00, full-time enrollment in the nursing program and a written essay concerning experience
and/or commitment to working with the aging population and in gerontological nursing settings.
Henderson Scholarship. One scholarship is awarded annually to a full time nursing student with
a 3.0 or above GPA who demonstrates leadership qualities. Awards will be made with regard to
financial need and will be renewed automatically so long as the student maintains satisfactory
progress in the nursing program.
Hesse, J. Francis Scholarship. Must be enrolled full time in the WSU nursing program.
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Financial need required. Not renewed automatically.
Huntington, Patricia J. McNamara-Memorial Endowed Scholarship. Full or part time
entering the first year of the undergraduate program at WSU. Financial need must be documented
in the FAFSA. Submit a 750 word essay to be reviewed outlining: why the student wishes to
pursue nursing and what are their aspirations in serving as a nurse. Must maintain a 3.0 GPA.
May be renewed for 2 years or until graduation.
J. Eleanor Webb Endowed Scholarship in Nursing. Scholarship will be awarded annually to
an undergraduate student(s) enrolled full or part-time in WSU Nursing. Award(s) will be made
without regards to financial need. The scholarship(s) may be renewed based upon satisfactory
academic progress.
Johnson Scholarship. Awards will be made with regard to financial need and will be renewed
automatically "so long as the student maintains satisfactory progress and in the judgment of the
nursing scholarship committee, maintains a positive attitude."
Dr. Susan Kruger, School of Nursing Scholarship. A BSN or MSN student who has earned a
3.5 or above GPA in 12 or more nursing credit hours and who demonstrates leadership qualities
can apply. Two letters of reference are required. The scholarship is renewable.
Lanz, Mildred L., Scholarship in Nursing. One scholarship will be awarded annually to a
student enrolled full-time in the Nursing Program. Preference given to a Kansas resident.
Recipient must have and maintain a 3.0 GPA. Award will be made with regard to financial need.
The scholarship will be renewed as long as the recipient meets the required criteria, but no
longer than four semesters.
Miles, Gene & Marie End. Scholarship. Full or part time student. Minimum GPA in
accordance to SON criteria. Financial need demonstrated through the FAFSA. Letter of reference
from college instructor/professor.
Ola Osborn Piper Scholarship. Several scholarships are available for WSU junior or senior
nursing students each year. The primary criterion for scholarship award is demonstration of
financial need. A letter of reference from a faculty member is also required.
Riordan, Dr. Janice-Endowed Scholarship. Full or part time student. Maintain a GPA of 3.0.
Demonstrate financial need through the FAFSA. May be renewed automatically with satisfactory
performance.
Rose, Paul C & John T Memorial Scholarship. Must be currently employed by Wesley
Medical Center in prenatal or neonatal special care units. Intent to concentrate career in prenatal
and/or neonatal care. Letter of recommendation from head of WMC prenatal unit. Minimum
GPA of 2.5. Short paragraph of current activities and future plans to donor facility.
Rose, Ray Memorial Endowed Nursing Scholar. Must be a graduate student in the MSN. GPA
must be at least a 3.0 or above. Awards are made with no regard to financial need. The
fellowship may be renewable.
Sanchez-Gietzen Scholarship. Scholarship is awarded to a student who is enrolled full or part
time in the BSN program. Academic merit and financial need is considered. One letter of
reference is required. Automatic renewal with satisfactory performance.
Shideler, Charles & Betty Scholarship. Full time enrollment in the BSN program. Minimum
GPA of 3.0. Demonstrated leadership qualities. One letter of reference. May be renewed with
satisfactory performance. Letter of intent confirming plans to remain in Kansas for 1 year after
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graduation.
Sterling, George E. & Blanche Scholarship. Scholarship will be awarded annually to a
student(s) enrolled full or part time at Wichita State University in the School of Nursing. No
recipient will be excluded from consideration based on race, religion, color, national origin,
gender, age, sexual orientation, marital status, or disability. Award(s) will be made without
regard to financial need.
Via Christi Endowed Scholarship in Nursing. Scholarship(s) will be awarded annually to an
undergraduate student(s) enrolled full-time at WSU in the School of Nursing. No recipient will
be excluded from consideration based on race, religion, color, national origin, gender age, sexual
orientation, marital status, status as a Vietnam Era Veteran or disability. Preference will be given
to Kansas residents. Recipient(s) must have and maintain a minimum of a 3.30 grade point
average. Awards(s) will be made without regard to financial need.
Zona Richardson Scholarships are available for students in all WSU nursing programs:
undergraduate, RN to BSN, RN to MSN and graduate. Scholarships can be renewed for a second
year. Criteria include GPA of 3.20, specified hours of enrollment, USA citizen or permanent
resident and reference letter from instructor or health care agency employer (supervisor). Awards
are made without regard to financial need. Preference will be given to students from Southwest
Kansas.
Wesley Women's Association Nursing Scholarship. One endowed scholarship is awarded
annually to a baccalaureate nursing student who has an outstanding academic record and
demonstrates leadership qualities. The scholarship is renewed automatically so long as
satisfactory academic progress is maintained. The recipient is asked to sign a letter of intent that
he/she will remain in the State of Kansas for at least one year after graduating from Wichita State
University.
Wesley Women’s Association Maternal/Child Nursing Scholarship. One endowed
scholarship is awarded annually to a graduate nursing student with an interest in maternal/child
nursing. A cumulative GPA of 3.25 or above, demonstrated leadership qualities and enrollment
in a minimum of six hours are required. An interview may be scheduled as part of the selection
process. The recipient is asked to sign a letter of intent that he/she will remain in the State of
Kansas for at least one year after graduating from Wichita State University.
Whittaker, Regina L. Behring Endowed. Must be a citizen of the USA and enrolled full-time.
Awards will be made with regard to financial need.