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MENNONITE COLLEGE OF NURSING AT ILLINOIS STATE UNIVERSITY PROUD: Pre-Entry and Retention Opportunities for Undergraduate Diversity

Freshman Form B: Application for Scholarship/Stipend for Fall 2014

PROUD (Pre-Entry and Retention Opportunities for Undergraduate Diversity) is a federally funded grant

awarded to Mennonite College of Nursing (MCN) to improve nursing workforce diversity.

One of the grant’s objectives is to increase access to and matriculation through Mennonite College of Nursing by

providing financial support to baccalaureate nursing students from disadvantaged backgrounds.

Pre-Entry Preparation Cohort (Freshmen and sophomores)– Stipends will be available to students participating

in the Pre-Matriculation Program. (Definition from HRSA: Stipend means a payment to an individual under a

fellowship or training grant in accordance with established levels to defray an individual’s living expenses during

the period of training.)

Academic Retention Cohort (Juniors, seniors, accelerated and RN to BSN students) – Stipends and scholarships

are available to provide financial support to assist with educational costs and living expenses. (A student may not

receive a scholarship and stipend concurrently.)

To be eligible for a scholarship or stipend, you must:

Be a member of PROUD. (To join PROUD, complete Form A. This is required

every semester.) All Mennonite College of Nursing Undergraduate students

are eligible to join PROUD.

Qualify for a PROUD scholarship or stipend based on grant guidelines. Please

refer to eligibility information on pages 5-6.

Instructions for Application for Scholarship/Stipend for Fall 2014

1. Completion of the application (Form B)

2. Enclosure of your 300-word (maximum) typewritten essay stating why you believe diversity in the nursing workforce is essential. (For current PROUD students, no essay is required.)

3. Submission of two recommendation forms completed by leaders in the community (ex: faculty, teachers, counselors, pastors/clergy) in signed, sealed envelopes. (For current PROUD students in good standing, 1 recommendation form is sufficient

NOTE: Incomplete applications, including missing materials, will not be considered. If you have questions, please contact PROUD at 309.438.1820.

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MENNONITE COLLEGE OF NURSING AT ILLINOIS STATE UNIVERSITY PROUD: Pre-Entry and Retention Opportunities for Undergraduate Diversity

Form B: Application for Scholarship/Stipend for Fall 2014

1. Student Status For Fall 2014, (circle semester and year): 1st semester or 2nd semester

Freshman Sophomore Junior Senior Accelerated RN to BSN

2. Name: _______________________________________ __________________________________ ________

Last First M.I.

3. How do you qualify for this scholarship/stipend? (You must meet at least one criteria to qualify

for scholarship/stipend – see page 5-6.)

a. How do you meet the definition of “individual from disadvantaged background? Please

briefly describe.

4. Cumulative GPA (write in most recent) _________________ (will be independently verified)

5. How many credit hours will you be taking in Fall 2014? ________________

Commitment:

If awarded a scholarship/stipend from Project PROUD, I agree to participate in at least 70% of

activities.

I understand attending Success Plan activities takes precedence over PROUD events and count as

PROUD activities.

I also agree that PROUD staff may check my grades using ReggieNet, Grades First or similar

software in order to perform academic interventions as necessary. I acknowledge attending

study sessions may help my academic success.

Signature:________________________________________________________ Date:____________________

Submit completed application by July 25th to:

PROUD Office in Edwards Hall, Room 303 or via mail:

MCN Proud, Campus Box 5815, Normal, IL 61790-5815

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MENNONITE COLLEGE OF NURSING AT ILLINOIS STATE UNIVERSITY PROUD: Pre-Entry and Retention Opportunities for Undergraduate Diversity

Recommendation Form for Scholarship/Stipend

Section A: To be completed by the applicant.

Name: __________________________________________________________________________

Please check your current year in school:

College : Freshman _____ Sophomore _____

Junior _____ Senior _____

Accelerated _____ RN to BSN _____

The Family Education Rights and Privacy Act of 1974 and its amendments guarantee students access to their educational records.

Students may, however, waive their right of access to recommendations. The choice of the applicant regarding this

recommendation is to be indicated below. Failure to sign will constitute acceptance of limited access.

____ I DO waive ____I DO NOT waive my right to inspect the contents of the following recommendation.

Section B: To be completed by the applicant’s reference & returned to applicant in sealed, signed envelope.

The person named above has applied for a stipend or scholarship through Project PROUD of Mennonite College of Nursing at Illinois State University, a federally–funded project to increase nursing workforce diversity. This person is requesting that you provide the following information. Please circle one number for each item that best represents the applicant’s ability in your judgment. Please mark N/A if question is not applicable to student or to your expertise area.

Unacceptable Below Average

Average Above Average

Out-standing

Not Applicable

1 2 3 4 5 N/A

Self-Directed 1 2 3 4 5 N/A Plans and follows through with appropriate actions independently.

Potential for Leadership 1 2 3 4 5 N/A Has ability to assume responsibility for improving status of self, groups, and/or organizations.

Clinical Competence 1 2 3 4 5 N/A Demonstrates sound clinical judgment, nursing interventions, and evaluation.

(Continued on next page)

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Unacceptable Below Average

Average Above Average

Out-standing

Not Applicable

1 2 3 4 5 N/A

Critical Thinking 1 2 3 4 5 N/A Bases decision-making/program-solving on systematic data collection and consideration of consequences of multiple options.

Written Communication 1 2 3 4 5 N/A Is precise in written communication. Verbal Communication 1 2 3 4 5 N/A

Is precise in verbal communication. Flexibility 1 2 3 4 5 N/A Changes or modifies a course of action as needed with poise and confidence.

Volunteerism 1 2 3 4 5 N/A Demonstrates commitment to service.

Goal Directed 1 2 3 4 5 N/A Committed to achieving specifically defined goals. Demonstrates perseverance and motivation.

Professional Integrity 1 2 3 4 5 N/A Actions are based on values and ethical principles.

Multicultural Sensitivity 1 2 3 4 5 N/A Values uniqueness of all persons and

recognizes gifts of diversity. Please indicate the strength of your endorsement of this candidate by placing an X on this scale: : : : : : Not recommend Recommend with reservation Recommend without reservation Highly recommend

Please make any additional comments that would be helpful in evaluating this applicant’s potential for receiving financial assistance to attend nursing education programming. Attach additional pages as needed for comments.

Name____________________________________Position___________________________________ Telephone______________________________Signature____________________________________ After completing this form, please insert it in an envelope, then sign the envelope across the seal, and return to the applicant for submission with the remaining application materials. (If that is not possible, please mail the recommendation letter to: MCN PROUD, Campus Box 5815, Normal, IL 61790-5815.)

Thank you for your assistance.

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ELIGIBLE PROJECT PARTICIPANTS

Project participants must be U.S. Citizens, non-citizen nationals, or foreign nationals who possess visas

permitting permanent residence in the United States. Individuals on temporary or student visas are not

eligible participants and may not receive NWD grant support.

“Individual from a Disadvantaged Background” refers to an individual who:

1) Comes from an environment that has inhibited them from obtaining the knowledge, skills, and abilities

required to enroll in and graduate from a school of nursing (Educationally Disadvantaged). The

following are provided as examples of “Educationally Disadvantaged” for guidance only and are not

intended to be all-inclusive.

Examples:

1. Person from high school with low average SAT/ACT scores or below the average State test

results.

2. Person from a school district where 50 percent or less of graduates go to college.

3. Person who has a diagnosed physical or mental impairment that substantially limits

participation in educational experiences.

4. Person for who English is not their primary language and for whom language is still a barrier

to their academic performance.

5. Person who is first generation to attend college.

6. Person from a high school where at least 30 percent of enrolled students are eligible for free

or reduced price lunches.

Or

2) Comes from a family with an annual income below a level based on low-income thresholds

established by the U.S. Census Bureau, adjusted annually for changes in the Consumer Price Index

(Economically Disadvantaged).

The Secretary defines a ‘‘low income family’’ for programs included in Titles III, VII and VIII of the

PHS Act as having an annual income that does not exceed 200 percent of the Department’s poverty

guidelines. A family is a group of two or more individuals related by birth, marriage, or adoption

who live together or an individual who is not living with any relatives.

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2013 Poverty Guidelines for the 48 Contiguous States and the District of Columbia Back to Top (To access information

for Hawaii or Alaska:

https://www.federalregister.gov/articles/2013/10/25/2013-25275/low-income-levels-used-for-various-health-

professions-and-nursing-programs

Size of parents' family * Income level **

For families with more than 8 persons, add $8,040 for each additional person.

1 $22,980

2 31,020

3 39,060

4 47,100

5 55,140

6 63,180

7 71,220

8 79,260

* Includes only dependents listed on Federal income tax forms.

** Adjusted gross income for calendar year 2011.