Schrock Nursing Education Loan Application
Eligibility Criteria
1. I have been accepted into an accredited nursing program (choose
yes or no)
2. I am a citizen or lawful permanent resident of the United States
or District of Columbia (choose yes or no)
3. Upon graduation I will apply for nursing employment in Elkhart
County as outlined by the Schrock Nursing Loan Conditions (choose
yes or no)
4. I am a resident of or attend school in Elkhart County (choose yes
or no)
5. I am willing to be interviewed in person or over the phone by the
loan committee (choose yes or no)
Student Information
6. Prefix
7. First Name
8. Middle Initial
9. Last Name
10.
Birthdate
11.
Home Address
12.
City
13.
State
14.
Zip Code
15.
Email Address
16.
Best Contact Phone Number
17.
Marital Status (choose one – single, married, divorced,
widowed)
18.
Your employer (if not applicable, answer “none”)
19.
Occupation (if not applicable, answer “none)
Schools
20.
High School Attended
21.
Year Graduated
22.
Colleges or technical schools attended (if not applicable,
answer none)
23.
Degrees earned (if not applicable, answer “none”)
24.
Year graduated
25.
Educational Institute where funds would be used
26.
Mailing address of Educational Institute
27.
City
28.
State
29.
Zip Code
30.
Phone
31.
What degree are you seeking?
32.
What is your anticipated, or intended college graduation
date?
33.
Date financial assistance is needed
More About You
34.
Cumulative GPA at your last educational experience
35.
Have you or will you complete the FAFSA by the March 10
deadline?
36.
If NO to the above, please explain
37.
Please list scholarships you have been granted with dollar
amounts. Do not list pending awards.
Financial Information
38.
Financial assistance you are requesting from the Schrock
Nursing Fund for this year (dollar amount up to $2,500 per
semester)
39.
Can you provide evidence that you have a credit score
greater than 680? If yes, skip to question 55.
40.
If no, can you provide evidence that a co-signor for this
loan has a credit score of 680 and a monthly income of $2,500? If
no, you are not eligible to apply.
Co-signor Information
The co-signor would be required to sign the promissory note in
addition to you in order for any approved funds to be released to the
educational institution.
41.
42.
43.
44.
45.
46.
Co-signor
Co-signor
Co-signor
Co-signor
Co-signor
Co-signor
prefix
First Name
Middle Initial
Last Name
Home Address
City
47.
Co-signor Street
48.
Co-signor Zip Code
49.
Co-signor Email Address
50.
Co-signor Phone Number
51.
Co-signor Marital Status (choose one: single, married,
divorced, widowed)
52.
Co-signor Employer
53.
Co-signor Occupation
54.
Co-signor Date of Birth
Tell us a little about yourself
55.
Why have you chosen a career in nursing? (max 500 words)
56.
What are your career goals in the years after you complete
your degree? (max 250 words)
57.
I have read and understand the Schrock Nursing Education
Loan conditions. If you have questions please call our office at
574.533.4500 or email us at foundation@givetogoshen.org
Finishing up
Please upload the following documents with your application. Your
application will not be processed without this information.
58.
A current copy of your FAFSA
59.
A transcript from your most recent completed year of school
60.
Your or your co-signor’s credit score with your name and
address on it
61.
If you are using a co-signor, two of their most recent pay
stubs or the most current year’s tax return as evidence of income
62.
A copy of your SAT or ACT scores if those scores are not a
part of the transcript you provided.
63.
A head/shoulder photo of you. By submitting this photo you
are acknowledging that you are giving Well Foundation Goshen
permission to use your photo in marketing materials should you be
awarded a loan.
64.
A copy of your birth certificate or proof of
citizenship/legal residency.
65.
I acknowledge through my signature below that all
information in this application is true and valid
66.
If using a co-signor, their signature is required as well.
As the c0-signor of this loan, I acknowledge through my
signature below that all information in this application is true
and valid (