S.E.P.A.B.N.A. SCHOLARSHIP APPLICATION

*Applicants must be an active member of SEPABNA*

Name:________________________________________________________________         

Address:____________________________________________________________         ___

Phone Number: ______________  Cell Number: ____________________

Are you:      currently a licensed nurse? Y      N                        SEPABNA member? Y      N __

Nursing School Enrollment:

School Name: ______________________________________________________    ______   

School Address: ____________________________________________       ________

Phone Number: _____________________________________________________      

Current Scholastic Level: Undergraduate (Indicate Year)    _______________________ 

                                               Graduate (Type of Program)        ________________________

Current GPA ____                              _      Expected date of graduation ___             _____                    __

Dean/Director _______________________________________________________

Previous Education (Attach a separate sheet if necessary):

__________________________________________________________________________

__________________________________________________________________________

Employment History—Include type, location, and dates of employment (Attach a separate sheet if necessary):

1.

2.

3.

Extracurricular/Community Activities (Please List):

_______________________________________________________________________             

____________________________________________________________         ____

__________________________________________________________________             

                         ________________                                                                                                                                          _       

Guidelines

• Members of the SEPABNA scholarship committee cannot apply for chapter scholarships.
• Active members are eligible for only one scholarship award per program per year.

Additional Requirements:

Submit a 1 (one) page typewritten double spaced essay, 12 font, Times Roman, which comprehensively and concisely addresses the following “Why I should receive a nursing scholarship? How will I contribute to SEPABNA?”

Proof of active participation in SEPABNA through attendance of meetings, participation in committees, and/or in community/professional events sponsored by SEPABNA for at least 6 months prior to submitting a scholarship application. Attendance in at least 5 activities is expected.

Include an updated resume or CV indicating relevant information such as your community involvement, achievements and educational goals. Professional presentation of this material is critical.

Submit proof of matriculation/acceptance (official transcript) and at least 3 (three) letters of recommendation. One recommendation letter must be from a SEPABNA Board member, one from your nursing school, and one personal reference. Applications MUST be received by March 30th of the current year.

I hereby affirm that all information provided is true. I understand that any false statements will forfeit the award. If I am the recipient of a scholarship, I agree to remain an active* SEPABNA member for a period of at least 2(two) years after receiving the scholarship. An active member denotes presence and/or participation @ 50% or 5 general SEPABNA meetings per year and participation at SEPABNA events are highly recommended.

Print Name: ______________________    _______ Signature: ______________________      __

Date: __________________      ________________

SEPABNA membership meetings are held at 5:30 pm, the first Wednesday of each month at Mercy Hospital of Philadelphia, 501 South 54^th Street, Philadelphia, PA 19143 . No meetings are held during the months of July and August. In February, SEPABNA meets the second Wednesday of the month. Please enclose all required information. Incomplete applications may not be considered and consequently may not meet application deadlines. Send all completed information to South Eastern Pennsylvania Area Black Nurses Association, PO Box 42463, Philadelphia, PA 19101-2463.

If you have any questions/ concerns, please contact Roberta Waite, Ed.D, RN @ (215) 762-4975

Revised 01-07-2011 RLW                                                                                  

Rev. 06-01-2012 CBW

Kindly send all SEPABNA Scholarship materials to:

Dr. Lucy E. Yates

 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Inez Tory Scholarship Award

More Information Coming - Deadline for Applications will be April 30, 2013

 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

APPLY NOW!

Minority Nurse Scholarship Program

We are currently accepting applications for our 14th annual scholarship competition, consisting of two $1,000 awards and one $3,000 award. Scholarships will be paid in summer 2013 for the fall 2013 academic term.

www.minoritynurse.com/2013scholarship