CHS Scholarship for Nursing - Foundation for SPS

Central High School

Purpose of the Fund: The Central High School Scholarship for Nursing to honor school nurses was established by Martha and William Sutherlin to assist and motivate students to continue their education who plan to study to become a registered nurse (professional RN), emphasis to be given to a student planning to attain a BSN in nursing.

In order to apply for the CHS Scholarship for Nursing, you must answer yes to the following:

Are you a graduating senior from Central High School?
Are you accepted to a university, college or trade school?
Are you planning to study nursing?
Do you have financial need? This should be addressed in your essay.
Do you have at least a 3.0 GPA?

Apply

"*" indicates required fields

Your School Name*

Personal Information

First Name*

Last Name*

Date of Birth*

MM/DD/YYYY Format (ex. 07/20/1995)

Applicant Email*

Enter Email Confirm Email

Cell Number*

Street Address*

City, State*

Zip Code*

Parent/Guardian Name(s)

Parent/Guardian Name(s)*

Parent/Guardian Cell Phone*

Parent/Guardian Email Address*

Signature

By signing this application, you are verifying the accuracy of your completed form.

Student Signature: *Type your name to sign your application.*

Date:*

MM/DD/YYYY Format

Parent/Guardian Signature: *Type parent/guardian signature.*

Date:*

MM/DD/YYYY Format

Academic Information

Weighted High School GPA*

Unweighted High School GPA*

ACT Composite Score

SAT Reading Score and SAT Math Score

College/University Information

Educational Institute You Plan to Attend In The Fall*

City/State of Institute:*

Have you applied?*

Have you been accepted?*

What do you plan to major in?*

Leadership & Extracurricular Activities: List leadership and extracurricular activities you were involved in throughout high school, starting with the most recent.*

Community Service: List any community service (include dates) that you have performed during high school, starting with the most recent.*

Work Experience: List jobs you have held during high school, starting with the most recent.*

Honors and Awards: List scholastic awards, extracurricular activity awards, or civic honors that you have received during high school, starting with the most recent.*

A+ And Other Scholarships Received: Including A+, please list any other financial aid including scholarships and grants that you are receiving and the amounts of each scholarship.*

Parent Financial Information

Complete the financial section based on your most recent IRS 1040. If parents are divorced or separated, answer the questions for the parent in which you applicant lived with the most in the past 12 months. If the applicant has lived with both parents an equal number of days in the past 12 months, include the parent who provided the largest amount of support to the student. If that parent has remarried, the stepparent's information must be included. If the applicant has been living independently from the parent/guardian, please indicate this. If some of the questions below are not applicable, please enter N/A in the box.

Father's Name*

Age and Occupation*

Mother's Name*

Age and Occupation*

Stepfather's Name*

Age and Occupation*

Stepmother's Name*

Age and Occupation*

Custodial Parent's Marital Status As Of Today*

Number of people in family, not including parents, who will receive the majority of parental support this calendar year. Include dependent children and other individuals living in the household who receive more than half their support from parents or guardians.*

Name and age of dependents.*

Number of dependent children, including applicant, as defined above, attending college this calendar year and taking a minimum of 8 hours of college credit.*

Based on your most recent IRS 1040, indicate the custodial parent(s) adjusted gross income. Round up to the nearest $100.*

Note- If you have extenuating financial circumstances, please explain here. (1,000 character limit)*

Student Essay

Please describe your goals for the future to show how your high school or work experiences have had an impact on you personally. Explain how you qualify for this specific scholarship. (3,000 character limit).*

Transcripts*

Drop files here or

Max. file size: 49 MB.

Please upload a copy of your transcripts.

Letters of Recommendation*

Please upload at least two letters of recommendation from a teacher, counselor or coach from your high school.

Drop files here or

Max. file size: 49 MB.

References

Reference 1*

Reference 1 Email*

Reference 1 Phone*

Reference 2*

Reference 2 Email*

Reference 2 Phone*

Hidden

Name of Scholarship

Central High School

Apply

Personal Information

Parent/Guardian Name(s)

Signature

Academic Information

College/University Information

Parent Financial Information

Student Essay

References

Section Break