Please read and follow all instructions so that your application may be considered.
1.
When you submit this application it is for all School of Nursing fellowships available for graduate students for the next academic year . Be sure to read the entire application.
2.
Submission information.
Completed Fellowship applications must be received in the School of Nursing by 5:00 p.m. on
February 28, 2014 or mailed with a postmark of no later than February 28, 2014 . Faxed copies are not acceptable. You should apply by the deadline even if you are unsure if you have been admitted to a specific program. Submit completed applications to room 116 in the Moore Building or mail to: Scholarship Committee, School of Nursing, UNCG, P.O. Box 26170,
Greensboro, NC 27402-6170.
3.
Supplementary materials.
You must file a FAFSA (Free Application for Federal Student Aid) by priority deadline of March 1,
2014 in order to be considered for any fellowships based on financial need. FAFSAs are available from the Financial Aid Office, or online at http://www.fafsa.ed.gov/. NOTE: NOT ALL SCHOLARSHIPS REQUIRE FINANCIAL NEED.
4.
Instructions for completing this application.
Fill out all the information requested on this cover sheet. Answer the questions (1-
8) on no more than two (2) additional single-sided sheets of paper. Type your responses. Put your name at the top of each additional page. Attach your response sheets to this completed cover sheet.
5.
Please note.
This application for fellowships is for the 2014-2015 academic year only. You must reapply for School of
Nursing fellowships each year.
Full Name_____________________________________________________University ID #:_______________________
Complete Mailing Address in June 2014: ______________________________________________________________
Phone Number ( )
Current Status (check one):

MSN student

post-MSN student
 PhD student
______________________________________________________________
County ( not country ) of Permanent Residence__________________________
MSN Concentration/Program:

Education-campus or online

Education-Hickory

Administration
 Anesthesia


MSN/MBA
A/GNP
Are you considered a North Carolina resident for tuition purposes?  yes
Are you a veteran of any branch of the military?

yes
Are you in the reserves of any branch of the military?  yes



no
no
no
What is your current county of employment: ___________________________ ___N/A not currently employed
Did you graduate from high school in NC? __ NO __ YES: county of high school ___________________________
Please answer the following questions on additional sheets of paper (as noted in #4 above):
1.
Make a brief statement describing your career goals and personal attributes.
2.
If you are currently working, briefly describe your job and identify how many hours you work each week.
3.
Briefly describe any health care related work you have done (for pay or as a volunteer).
4.
List any fellowships you currently have. Do these continue next year?
5.
List any honors or achievements.
6.
List membership in campus or professional organizations and any offices held.
7.
Describe circumstances that make your financial need special.
8.
List any other information you would like to share with the Scholarship Committee.
The School of Nursing cannot award all applicants. Make sure your application presents a complete, succinct picture of your strengths, your needs, and your career goals. Please see the NEXT PAGE for additional information about additional fellowship opportunities for students pursuing the Adult/Gerontological Nurse Practitioner concentration and for PhD students.
Application Deadline for this year: February 28, 2014
Decisions will be made and applicants notified by mid-June
PhD and MSN SON Scholarship app 2014-2015

I.
Additional Opportunities for Adult/Gerontological Nurse Practitioner Students
General Requirements for fellowships for A/GNP students:

Must be admitted to the A/GNP Program

Personal attributes include demonstrated commitment to a career dedicated to caring for the elderly as a geriatric nurse practitioner.

If you are currently working, describe your job as it relates to the care of the elderly.

List all professional nursing organizations that you are a member of.

Describe any health care related work with the elderly you have done (for pay or as a volunteer).

Following your completion of the A/GNP program, please describe your ideal/desired professional placement.
In order to be considered for the William Randolph Hearst Endowed Fellowship for Geriatric Nurse
Practitioners please answer the following questions:
1.
Describe your commitment to the Adult/Geriatric Nurse Practitioner profession and your personal commitment to provide health care services to older adults in the community
2.
Upon completion of the A/GNP program, are you willing to commit to passing the national
Adult/Gerontology Primary Care Nurse Practitioner certification examination?
If you are applying for the William Randolph Hearst Endowed Fellowship for Geriatric Nurse
Practitioners, the Bates Fellowship in Gerontological Nursing, or the Roena Bullis Kulynych
Fellowship in Geriatric Nursing you may use up to three additional single-sided sheets of paper (see item 4 at the top of the preceding page) instead of two.
II.
Additional Opportunities for PhD Students
Current Status (check one):

Newly admitted PhD student

Have completed first year of PhD program
(NUR 701, 702, 710, 712 & 781)

Have completed second year of PhD program
(NUR 703, 704, 782, 790

Have completed third year of PhD program
Current enrollment (check any that apply):



NUR 790 Directed Research
NUR 792 Independent Study or 803 research Extension
NUR 799 Dissertation or 802 Dissertation Extension
(NUR 741, 783)

Other. Describe status in PhD program: ______________________________
PhD Students: please answer the following questions on no more than two additional sheets of paper:
1.
Are you currently conducting any research (through Directed Research, Dissertation, Independent Study or other coursework) in the areas of health promotion and/or management of chronic disease in vulnerable populations?
___ No ___ Yes If so, briefly describe the research:
2.
Have you completed conduct of any research (through Directed Research, Dissertation, Independent Study or other coursework) in the areas of health promotion and/or management of chronic disease in vulnerable populations? ___ No ___ Yes If so, briefly describe the research:
3.
Do you intend to conduct of research (through Directed Research, Dissertation, Independent Study or other coursework) in the areas of health promotion and/or management of chronic disease in vulnerable populations?
___No ___ Yes If so, briefly describe the research:
4.
Briefly describe any health care related work you have done (for pay or as a volunteer) in the areas of health promotion and/or management of chronic disease in vulnerable populations.
PhD and MSN SON Scholarship app 2014-2015

Address of the School of Nursing for returning applications:
Dr. Anita Tesh
UNCG School of Nursing
PO Box 26170
Greensboro, NC 27402-6170
Telephone (336) 334-5282
FAX: (336) 334-3628
Room 117
Margaret C. Moore Building
UNCG School of Nursing
PhD and MSN SON Scholarship app 2014-2015