Florence Brown Scholarship Application For Undergraduate Students
Florence Brown Scholarship Application For Undergraduate Students
Florence Brown Scholarship Application For Undergraduate Students
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<strong>Florence</strong> <strong>Brown</strong> <strong>Scholarship</strong> <strong>Application</strong><br />
<strong>For</strong> <strong>Undergraduate</strong> <strong>Students</strong><br />
Please complete the following form for consideration by Temple University College of Health<br />
Professions and Social Work Department of Nursing for a <strong>Florence</strong> <strong>Brown</strong> <strong>Scholarship</strong> for<br />
academic year 2011-2012.<br />
Deadline for Submission: September 16, 2011<br />
1. Name: ______________________________________________________<br />
(print)<br />
Signature: ___________________________________________________<br />
Date: ___________________________________________________<br />
2. Mailing Address during academic year (September-May):<br />
______________________________________________________________<br />
Street<br />
______________________________________________________________<br />
City<br />
______________________________________________________________<br />
State, Zip Code<br />
3. Temple University E-mail address: _________________________________<br />
4. Preferred telephone number: _____________________________________<br />
5. Fall 2011 four-year BSN Program class standing: Sophomore Junior<br />
6. Expected Graduation Date: (Month/Year) ___________________________<br />
7. Employment Experience: Please attach a resume.<br />
8. Personal Essay of no more than 250 words describing your career plans in nursing, as<br />
well as your voluntary activities within your community.<br />
9. Please attach a brief personal statement regarding your financial need, if appropriate.<br />
This statement must address how this scholarship would aid you to meet your academic<br />
goals.<br />
10. Are you current receiving financial aid? Yes No
11. <strong>For</strong> the current academic year you are applying for the <strong>Florence</strong> <strong>Brown</strong> <strong>Scholarship</strong>,<br />
please provide the following information, if it is relevant to you:<br />
Amount of Loans awarded: $________________<br />
Amount of Grants awarded: $________________<br />
Amount of <strong>Scholarship</strong>s awarded: $________________<br />
Amount of Other awards: $________________<br />
12. Submit your current academic transcript from Temple University (note: a student copy<br />
is acceptable).<br />
13. Attached two letters of recommendation; at least one must be from a faculty member<br />
(see attached form). These recommendations must be sent directly from the<br />
recommending individuals directly to the address provided on the form.<br />
Please send completed application and attachments (i.e., Resume [if appropriate], Personal<br />
Essay, Personal Statement Regarding Financial Need [if appropriate], and Current Temple<br />
University Transcript [student copy acceptable]) to:<br />
Ms. Andrea Darden<br />
Department of Nursing<br />
Temple University<br />
College of Health Professions and Social Work<br />
3307 North Broad Street<br />
Philadelphia, Pennsylvania 19140<br />
<strong>For</strong> additional information regarding this application, please contact<br />
Ms. Andrea Darden at 215-707-4687 or e-mail at andrea.darden@temple.edu.
<strong>Florence</strong> <strong>Brown</strong> <strong>Scholarship</strong> <strong>Application</strong><br />
Recommendation <strong>For</strong>m<br />
Name of Applicant: __________________________________________________<br />
(print)<br />
I, _______________________________ (Student’s Signature), give permission for the<br />
above-named individual to provide a reference.<br />
Individual Completing the Recommendation <strong>For</strong>m:<br />
1. Name: ______________________________________________________<br />
(print)<br />
2. Title: ______________________________________________________<br />
(print)<br />
Institution: ______________________________________________________<br />
(print)<br />
3. Mailing Address:<br />
______________________________________________________________<br />
Street<br />
______________________________________________________________<br />
City<br />
______________________________________________________________<br />
State, Zip Code<br />
4. E-mail address: _________________________________<br />
5. Telephone number: _________________________________<br />
6. FAX number: _________________________________
Evaluation: In comparison with a representative group of undergraduate students who have<br />
had approximately the same amount of experience and training, how do you rate the applicant<br />
in:<br />
Item<br />
• General academic ability<br />
• Leadership potential<br />
• Motivation and initiative<br />
• Ability to work with others<br />
• Imagination and creativity<br />
• Potential to succeed<br />
Excellent<br />
Upper 5%<br />
Above Average<br />
Upper 10%<br />
Average<br />
Upper 25%<br />
Additional Comments: (Please do not attach additional letters)<br />
Please use the rest of this form to comment on any aspect of the applicant’s background,<br />
experiences, community involvement, etc., that you feel will assist the review committee<br />
evaluate this student’s application. Thank you.<br />
_____________________________________________________________________________<br />
_____________________________________________________________________________<br />
_____________________________________________________________________________<br />
_____________________________________________________________________________<br />
_____________________________________________________________________________<br />
_____________________________________________________________________________<br />
_____________________________________________________________________________<br />
_____________________________________________________________________________<br />
_____________________________________________________________________________<br />
_____________________________________________________________________________<br />
_____________________________________________________________________________<br />
_____________________________________________________________________________<br />
Signature: _________________________________________ Date: ____________________<br />
Please return this form to:<br />
Ms. Andrea Darden<br />
Department of Nursing<br />
Temple University<br />
College of Health Professions and Social Work<br />
3307 North Broad Street<br />
Philadelphia, Pennsylvania 19140<br />
Thank you.
<strong>Florence</strong> <strong>Brown</strong> <strong>Scholarship</strong> <strong>Application</strong><br />
Recommendation <strong>For</strong>m<br />
Name of Applicant: __________________________________________________<br />
(print)<br />
I, _______________________________ (Student’s Signature), give permission for the<br />
above-named individual to provide a reference.<br />
Individual Completing the Recommendation <strong>For</strong>m:<br />
1. Name: ______________________________________________________<br />
(print)<br />
2. Title: ______________________________________________________<br />
(print)<br />
Institution: ______________________________________________________<br />
(print)<br />
3. Mailing Address:<br />
______________________________________________________________<br />
Street<br />
______________________________________________________________<br />
City<br />
______________________________________________________________<br />
State, Zip Code<br />
4. E-mail address: _________________________________<br />
5. Telephone number: _________________________________<br />
6. FAX number: _________________________________
Evaluation: In comparison with a representative group of undergraduate students who have<br />
had approximately the same amount of experience and training, how do you rate the applicant<br />
in:<br />
Item<br />
• General academic ability<br />
• Leadership potential<br />
• Motivation and initiative<br />
• Ability to work with others<br />
• Imagination and creativity<br />
• Potential to succeed<br />
Excellent<br />
Upper 5%<br />
Above Average<br />
Upper 10%<br />
Average<br />
Upper 25%<br />
Additional Comments: (Please do not attach additional letters)<br />
Please use the rest of this form to comment on any aspect of the applicant’s background,<br />
experiences, community involvement, etc., that you feel will assist the review committee<br />
evaluate this student’s application. Thank you.<br />
_____________________________________________________________________________<br />
_____________________________________________________________________________<br />
_____________________________________________________________________________<br />
_____________________________________________________________________________<br />
_____________________________________________________________________________<br />
_____________________________________________________________________________<br />
_____________________________________________________________________________<br />
_____________________________________________________________________________<br />
_____________________________________________________________________________<br />
_____________________________________________________________________________<br />
_____________________________________________________________________________<br />
_____________________________________________________________________________<br />
Signature: _________________________________________ Date: ____________________<br />
Please return this form to:<br />
Ms. Andrea Darden<br />
Department of Nursing<br />
Temple University<br />
College of Health Professions and Social Work<br />
3307 North Broad Street<br />
Philadelphia, Pennsylvania 19140<br />
Thank you.