J. Russell Fawley Scholarship Application For Undergraduate ...

J. Russell Fawley Scholarship Application
For Undergraduate Students
Please complete the following form for consideration by Temple University College of Health
Professions and Social Work Department of Nursing for a J. Russell Fawley Scholarship for
academic year 2011-2012.
Deadline for Submission: September 16, 2011
1. Name: ______________________________________________________
(print)
Signature: ___________________________________________________
Date: ___________________________________________________
2. Mailing Address during academic year (September-May):
______________________________________________________________
Street
______________________________________________________________
City
______________________________________________________________
State, Zip Code
3. Temple University E-mail address: _________________________________
4. Preferred telephone number: _____________________________________
5. Fall 2011 upper division BSN Program class standing: Junior Senior
6. Expected Graduation Date: (Month/Year) ___________________________
7. Employment Experience: Please attach a resume.
8. Personal Essay of no more than 250 words describing your career plans in nursing, as
well as your long-term aspirations.
9. Please attach a brief personal statement regarding your financial need, if appropriate.
This statement must address how this scholarship would aid you to meet your academic
goals.
10. Are you current receiving financial aid? Yes No

11. For the current academic year you are applying for the J. Russell Fawley Scholarship,
please provide the following information, if it is relevant to you:
Amount of Loans awarded: $________________
Amount of Grants awarded: $________________
Amount of Scholarships awarded: $________________
Amount of Other awards: $________________
12. Submit your current academic transcript from Temple University (note: a student copy
is acceptable).
13. Attached two letters of recommendation; at least one must be from a faculty member
(see attached form). These recommendations must be sent directly from the
recommending individuals directly to the address provided on the form.
Please send completed application and attachments (i.e., Resume [if appropriate], Personal
Essay, Personal Statement Regarding Financial Need [if appropriate], and Current Temple
University Transcript [student copy acceptable]) to:
Ms. Andrea Darden
Department of Nursing
Temple University
College of Health Professions and Social Work
3307 North Broad Street
Philadelphia, Pennsylvania 19140
For additional information regarding this application, please contact
Ms. Andrea Darden at 215-707-4687 or e-mail at andrea.darden@temple.edu.

J. Russell Fawley Scholarship Application
Recommendation Form
Name of Applicant: __________________________________________________
(print)
I, _______________________________ (Student’s Signature), give permission for the
above-named individual to provide a reference.
Individual Completing the Recommendation Form:
1. Name: ______________________________________________________
(print)
2. Title: ______________________________________________________
(print)
Institution: ______________________________________________________
(print)
3. Mailing Address:
______________________________________________________________
Street
______________________________________________________________
City
______________________________________________________________
State, Zip Code
4. E-mail address: _________________________________
5. Telephone number: _________________________________
6. FAX number: _________________________________

Evaluation: In comparison with a representative group of undergraduate students who have
had approximately the same amount of experience and training, how do you rate the applicant
in:
Item
• General academic ability
• Leadership potential
• Motivation and initiative
• Ability to work with others
• Imagination and creativity
• Potential to succeed
Excellent
Upper 5%
Above Average
Upper 10%
Average
Upper 25%
Additional Comments: (Please do not attach additional letters)
Please use the rest of this form to comment on any aspect of the applicant’s background,
experiences, community involvement, etc., that you feel will assist the review committee
evaluate this student’s application. Thank you.
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Signature: _________________________________________ Date: ____________________
Please return this form to:
Ms. Andrea Darden
Department of Nursing
Temple University
College of Health Professions and Social Work
3307 North Broad Street
Philadelphia, Pennsylvania 19140
Thank you.

J. Russell Fawley Scholarship Application
Recommendation Form
Name of Applicant: __________________________________________________
(print)
I, _______________________________ (Student’s Signature), give permission for the
above-named individual to provide a reference.
Individual Completing the Recommendation Form:
1. Name: ______________________________________________________
(print)
2. Title: ______________________________________________________
(print)
Institution: ______________________________________________________
(print)
3. Mailing Address:
______________________________________________________________
Street
______________________________________________________________
City
______________________________________________________________
State, Zip Code
4. E-mail address: _________________________________
5. Telephone number: _________________________________
6. FAX number: _________________________________

Evaluation: In comparison with a representative group of undergraduate students who have
had approximately the same amount of experience and training, how do you rate the applicant
in:
Item
• General academic ability
• Leadership potential
• Motivation and initiative
• Ability to work with others
• Imagination and creativity
• Potential to succeed
Excellent
Upper 5%
Above Average
Upper 10%
Average
Upper 25%
Additional Comments: (Please do not attach additional letters)
Please use the rest of this form to comment on any aspect of the applicant’s background,
experiences, community involvement, etc., that you feel will assist the review committee
evaluate this student’s application. Thank you.
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Signature: _________________________________________ Date: ____________________
Please return this form to:
Ms. Andrea Darden
Department of Nursing
Temple University
College of Health Professions and Social Work
3307 North Broad Street
Philadelphia, Pennsylvania 19140
Thank you.