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LPN to RN SCHOLARSHIP APPLICATION

Purpose Statement:

This scholarship is to support the educational goal of becoming a Registered Nurse. It is awarded to an individual who has applied

for or been accepted to a LPN to RN program in Pierce County. Scholarship amounts range from $500-$1,000, depending on num-

ber of qualified applications received.

Application Deadline & Scholarship Award:

Application must be postmarked by March 31st. We do not accept electronic submissions.

Mail applications to:

Pierce County Nurses Association

Scholarship Committee

223 Tacoma Avenue South

Tacoma, WA 98402

Required Materials:

□ Completed PCNA scholarship application form.

□ One letter of recommendation from someone who has supervised you at school or work, such as a clinical instructor who knows you

well or a supervisor from your job.

□ Documentation of your grade point average (an unofficial transcript is acceptable)

□ Documentation of employment in health care fields (can be in resume form)

□ Essay, not more than two pages long, covering the following areas:

A) Personal Statement

B) Work Experience

C) Community Involvement & Leadership

D) Educational goals and career goals

Attendance at the PCNA Spring Banquet presentation during Nurses’ Week is requested. In 2018, the date for the Banquet is Friday, May 11th.

Dinner for yourself and two guests will be provided by PCNA. If awarded a scholarship, please be prepared to provide a photo of yourself for pub-

lication online & in our newsletter.

223 Tacoma Avenue South

Tacoma, WA 98402

253.572.7337

office@piercecountynurses.com

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LPN to RN SCHOLARSHIP APPLICATION Applicant Information:

Name:

_____________________________________________________________________________

Address: Phone:

_____________________________________________________________ _______________________________________

_____________________________________________________________ Email: __________________________________

In the event of a scholarship award, I agree to allow PCNA to reprint in print & online my name, biographic information and photo-

graphic image: Yes No (circle one)

Eligibility Check List (Check all that apply):

□ Currently applying to, enrolled in or attending an RN to LPN program in Pierce County.

□ Minimum of a 2.5 GPA or documentation of 5+ years of LPN employment

Scholarships will be awarded on the basis of academic performance, school and community involvement and career goals. It is the

responsibility of the applicant to make certain a complete application, including completed letters of recommendation, is post-

marked by March 31, 2018. Incomplete applications will not be considered. If awarded a scholarship, funds will be mailed directly

to the program. If chosen for a scholarship before being enrolled in the program, scholarship funds will only be awarded if accept-

ed. Please verify your program’s mailing address and the contact person.

Academic Standing:

School you are currently attending: ____________________________________________________________________________

Current GPA: _______________ College or University that you plan to attend:_________________________________________

Have you been accepted? ___________________________________ Anticipated start date: _____________________________

*To receive the award, applicant must be accepted to or enrolled in a 2 year or 4 year accredited college or university.

If awarded, I designate this scholarship to be sent to the following college or university:

Name and Address of College/University (to which scholarship funds will be mailed): Contact Person & Phone Number:

______________________________________________________________ _______________________________________

______________________________________________________________ _______________________________________

______________________________________________________________ Student ID # _____________________________

223 Tacoma Avenue South

Tacoma, WA 98402

253.572.7337

office@piercecountynurses.com

(For office use only)

Date received at PCNA Office: