University of Pennsylvania Alumni Scholarship Fund

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					 ALUMNI ASSOCIATION OF THE SCHOOL OF NURSING OF
 THE HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA
              NURSING SCHOLARSHIP
In 1993, the Board of Directors of the Nurses' Alumni Association of the Hospital of the University
of Pennsylvania formed a task force to investigate options on how the organization might benefit
nursing education and the community. The task force reviewed current activities of the
Association, restrictions in its charter and its financial assets.

After thorough investigation and careful consideration, the task force recommended the creation of
the Alumni Association of the School of Nursing of the Hospital of the University of Pennsylvania
Nursing Scholarship Fund. The fund was placed with The Philadelphia Foundation.

The Philadelphia Foundation, a community foundation, was established in 1918 and serves the
southeastern Pennsylvania region. It is comprised of over 750 individually named charitable funds.
For more information, please visit our website at www.philafound.org.

The Scholarship Fund was designed to provide support and promote nursing. For the 2010-2011
academic year, one or more scholarships ranging from $500 to $1,000 will be awarded. The Fund
will provide scholarships for tuition assistance to persons entering nursing or for those who are
accepted in or enrolled in an NLN-accredited program (LPN, AD, diploma or BSN).

Recipients shall be selected on the basis of financial need, interest in the nursing profession, and
acceptance in an NLN-accredited program.

Scholarships shall be given in the following order of priority:

(1st) a candidate who is a relative of a graduate; for example a child, grandchild, niece or nephew

(2nd) a candidate proposed by a graduate

(3rd) a candidate who is a resident of Bucks, Chester, Delaware, Montgomery or Philadelphia
county in Pennsylvania; Burlington, Camden or Gloucester county in New Jersey or New Castle
county in Delaware.

Completed applications and recommendations must be submitted to the Foundation by
May 14, 2010.

   1234 Market Street, Suite 1800, Philadelphia, PA 19107-3794 p. 215-563-6417, f. 215-563-6882, www.philafound.org
Alumni Association of the School of Nursing of the                                          Page 2
Hospital of the University of Pennsylvania Nursing Scholarship

The Advisory Committee will review applications and make its decisions by June 30, 2010.

All applicants will be notified in writing of the decisions. The scholarship award will be forwarded
directly to the educational institution in the summer of 2010 to be applied to tuition costs for the
2009-2010 academic year.

Applications may be requested by phone, FAX, e-mail or in writing. By May 14, 2010,
completed applications, transcripts and recommendations must be received by mail or
delivered to:

The Philadelphia Foundation
Attn: Alumni HUP Scholarship
1234 Market Street, Suite 1800
Philadelphia, PA 19107

Phone: 215-563-6417, ext. 119
Fax: 215-563-6882
Email: mmarkovcy@philafound.org



02/2010
            ALUMNI ASSOCIATION OF THE SCHOOL OF NURSING
         OF THE HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA
                       NURSING SCHOLARSHIP
                                      SCHOLARSHIP APPLICATION

                              APPLICATION DEADLINE: May 14, 2010


CHECKLIST
   Completed all questions on the application form
   Requested an official high school transcript
   Requested an official post-secondary transcript (if applicable)
   Attached a copy of your school’s estimated costs and a description of how you plan to meet them
   Attached your statement of ASPIRATIONS AND GOALS
   Attached a letter of support from your sponsor
   Supplied Recommendation Forms to each of your two references
   Signed and dated the application form

By May 14, 2010, mail or deliver your completed application with attachments to:

          The Philadelphia Foundation
          Alumni HUP Scholarship
          1234 Market Street, Suite 1800
          Philadelphia, PA 19107

Please print or type. Application is seven pages long.
APPLICANT INFORMATION
Name
______________________________________________________________________________
Last                                                   First                                               Middle

Permanent Address
_____________________________________________________________________________
Street
_____________________________________________________________________________
City                                                    County                              State              Zip

Telephone (_____)_________________                     E-mail _________________________________

Date of birth ______________________

1234 Market Street, Suite 1800, Philadelphia, PA 19107-3794 p. 215-563-6417, f. 215-563-6882, www.philafound.org
FAMILY INFORMATION
Please check relationship.
Father /stepfather /guardian _______________________________________________
Address
_____________________________________________________________________________
Street                                                            City              State         Zip

Mother/stepmother/guardian___________________________________________________

Address______________________________________________________________________
          Street                                                 City               State         Zip

Check if applicable:                father deceased                      mother deceased
                                    parents separated                    parents divorced

Number of siblings financially dependent on parent(s)/guardian______________________

                                         OR
Name of spouse_______________________________________________________________

Address _____________________________________________________________________
            Street                                                City              State         Zip


                                         OR
Number of individuals financially dependent on you________________________________


HIGH SCHOOL INFORMATION

    Please have a copy of your official transcript mailed directly from your high school to the
    Foundation.


High school attended__________________________________________________________

Year of graduation________________                    Telephone (_______)___________________
HIGH SCHOOL ACTIVITIES

In the space provided below, please list extracurricular activities in which you have participated
during the past four years. Include clinical and practical experiences, and student
organizations.

You may attach a separate listing or your resume.


                                      # of        Leadership Positions, Letters Earned,
             Activity                Years/                Recognition, etc.
                                     Months




COMMUNITY AND PERSONAL ACTIVITIES
In the space provided below, please list community, religious and personal activities in which
you have participated during the past four years. Include volunteer work, particularly clinical
and practical experience, youth programs, athletic programs, music, scouting, community
service, etc.

You may attach a separate listing or your resume.


                                      # of                Leadership Positions
             Activity                Years/          Awards, Honors, Recognition, etc.
                                     Months
WORK EXPERIENCE
In the space provided below, please list any paid work experience (include self-employment, i.e.
baby sitting) you have had during the past four years. Include summer employment as well as
employment during the school year. Complete this information beginning with your most
recent work experience.

You may attach a separate listing or your resume.


         Employer                        Nature of Work                       Dates of              Hours
                                  (include supervisory positions)            Employment              per
                                                                                                    Week




POST SECONDARY EDUCATION INFORMATION
   If you are currently in a program, please have your official transcript mailed directly to the
   Foundation.
Program you plan to attend_____________________________________________________

Institution____________________________________________________________________

Address______________________________________________________________________
        Street                                                 City                State             Zip

Telephone (_______)________________

Will you be a full-time student            Yes       No

When do you anticipate completing your program?_________________________________
POST SECONDARY EDUCATION FINANCIAL AID INFORMATION
Have you received or been promised other financial aid (scholarships, loans, grants, etc.)?
Yes     No
If you have answered YES above, please provide the following information regarding other
financial assistance. You may attach a separate page if necessary.
Amount            Date Received           Term              Purpose
_____________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________



FINANCIAL INFORMATION -- PERSONAL
Financial need is one of the criteria for scholarship selection.
   Please attach a copy of your school’s estimated cost of attendance.
   How do you plan to meet these expenses (scholarships, loans, grants, employment,
   family, etc.)?
Please answer YES or NO:                                                    2009          2010
Did or will your parents/guardian claim you as an income tax exemption?______             ______
Did or will you get more than $1,000 worth of support from your             ______        ______
parents/guardian?
Did you live with your parents/guardian for more than six weeks
in either year?                                                            _______        ______


ASPIRATIONS AND GOALS
Please submit a statement on an attached sheet describing your personal aspirations and
educational and career goals. This statement should be 1-2 typewritten, double-spaced pages
and must include information that will answer each of the following questions:
       Why are you pursuing a career in nursing?

       In what area of nursing do you plan to specialize?
In the space below, please report any additional information or factors which you believe should
be considered by the Advisory Committee in reviewing your application.




HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA SCHOOL OF NURSING - SPONSOR

1. Are you related to a graduate of the Hospital of the University of Pennsylvania School of
   Nursing?     Yes       No
                                      OR
2. Are you being proposed for this scholarship by a graduate of the Hospital of the University
   of Pennsylvania School of Nursing? Yes          No
         NOTE: if possible, please enclose a letter of support from your sponsor.
Sponsor's name at graduation: __________________________________________________
Year of graduation __________________           Relationship ____________________________
Sponsor’s current name _______________________________________________________
Sponsor’s current address
____________________________________________________________________________
Street                                           City       State          Zip


Sponsor’s current telephone (_______)__________________________
REFERENCES
Please provide the following information for each of the two persons (non-relatives) to whom
you have given a Recommendation Form.

Reference #1

Name _______________________________________ Telephone (_______)_____________
Address

____________________________________________________________________________
Street                                          City       State          Zip

Reference #2

Name ____________________________________ Telephone (_______)_________________

Address

____________________________________________________________________________
Street                                          City       State          Zip


CERTIFICATION
I hereby affirm that the information provided on this form is accurate and complete to the best
of my knowledge.

I give to The Philadelphia Foundation permission to use my name and photograph in any print
or electronic media.


_____________________________________________________________________________
Signature                                                                               Date



Please review the checklist on page one of this application.


By May 14, 2010, mail or deliver your completed application with attachments to:

          The Philadelphia Foundation
          Alumni HUP Scholarship
          1234 Market Street, Suite 1800
          Philadelphia, PA 19107


02/2010
 ALUMNI ASSOCIATION OF THE SCHOOL OF NURSING OF THE HOSPITAL OF
     THE UNIVERSITY OF PENNSYLVANIA NURSING SCHOLARSHIP
                                 SCHOLARSHIP RECOMMENDATION FORM

                   Recommendation due to The Philadelphia Foundation by May 14, 2010

Applicant's Name__________________________________________ Date ________________________
                                       Print

Applicant's Signature ___________________________________________________________________
                                    NOTE: Signature grants permission to send information

Check in the appropriate column your estimate of each trait listed:
                                                                     Consistently       Moderately       Seldom

 1. In a work situation is the applicant:

    a. Resourceful

    b. Orderly

    c. Accurate

    d. Dependable

    e. Punctual

    f. Cooperative

    g. Thorough

    h. Adaptable

    i. Energetic

 2. Is the applicant:

    a. Sensitive to the reactions of others

    b. Trustworthy

    c. Tolerant

    d. Tactful

    e. Well poised

    f. Self-controlled
    g. Receptive to criticism



    1234 Market Street, Suite 1800, Philadelphia, PA 19107-3794 p. 215-563-6417, f. 215-563-6882, www.philafound.org
Applicant's Name _______________________________________________________________________

How long have you known the applicant? _______________________________________________________

  a. What do you consider the applicant's chief qualities?

        Strengths:


        Weaknesses:



  b. Does the applicant work well with people?



  c. Do you place full confidence in this applicant's integrity? Explain.



  d. Would you like this person to take care of you if you were ill?



4. Would you endorse this applicant to receive a scholarship from the Alumni Association of the School of
   the Hospital of the University of Pennsylvania Nursing Scholarship Fund?         Yes           No

  If your answer is "no," please comment.




Thank you for your help.

Name ________________________________________________________________________________
                                                 Print
Signature ____________________________________________________________________________

Position _____________________________________________________________________________

Address _____________________________________________________________________________

_____________________________________________________________________________________

Telephone (_______)______________________________ Date ______________________________


Please return this form by May 14, 2010 directly to:
        The Philadelphia Foundation
        Alumni-HUP Scholarship
        1234 Market Street, Suite 1800
        Philadelphia, PA 19107
                                                                                         02/2010
 ALUMNI ASSOCIATION OF THE SCHOOL OF NURSING OF THE HOSPITAL OF
     THE UNIVERSITY OF PENNSYLVANIA NURSING SCHOLARSHIP
                                 SCHOLARSHIP RECOMMENDATION FORM

                   Recommendation due to The Philadelphia Foundation by May 14, 2010

Applicant's Name__________________________________________ Date ________________________
                                       Print

Applicant's Signature ___________________________________________________________________
                                    NOTE: Signature grants permission to send information

Check in the appropriate column your estimate of each trait listed:
                                                                    Consistently            Moderately    Seldom

 1. In a work situation is the applicant:

    a. Resourceful

    b. Orderly

    c. Accurate

    d. Dependable

    e. Punctual

    f. Cooperative

    g. Thorough

    h. Adaptable

    i. Energetic

 2. Is the applicant:

    a. Sensitive to the reactions of others

    b. Trustworthy

    c. Tolerant

    d. Tactful

    e. Well poised

    f. Self-controlled
    g. Receptive to criticism



    1234 Market Street, Suite 1800, Philadelphia, PA 19107-3794 p. 215-563-6417, f. 215-563-6882, www.philafound.org
Applicant's Name _______________________________________________________________________

How long have you known the applicant? _______________________________________________________

  a. What do you consider the applicant's chief qualities?

        Strengths:


        Weaknesses:



  b. Does the applicant work well with people?



  c. Do you place full confidence in this applicant's integrity? Explain.



  d. Would you like this person to take care of you if you were ill?



4. Would you endorse this applicant to receive a scholarship from the Alumni Association of the School of
   the Hospital of the University of Pennsylvania Nursing Scholarship Fund?         Yes           No

  If your answer is "no," please comment.




Thank you for your help.

Name ________________________________________________________________________________
                                                 Print
Signature ____________________________________________________________________________

Position _____________________________________________________________________________

Address _____________________________________________________________________________

_____________________________________________________________________________________

Telephone (_______)______________________________ Date ______________________________


Please return this form by May 14, 2010 directly to:
        The Philadelphia Foundation
        Alumni-HUP Scholarship
        1234 Market Street, Suite 1800
        Philadelphia, PA 19107
                                                                                                 02/2010

				
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