the BESt 4.0 HBSON Application

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BEST 4.0 APPLICATION 2015

BEST 4.0 is a free program designed to increase diversity in the nursing workforce and promote academic excellence. The project targets pre-nursing students at Hunter College and sophomores, juniors and seniors of the Hunter Bellevue School of Nursing.

Identification

Name

Date of Birth

Gender

Cell Phone Number

Hunter College Email

Full Address

City

State

ZIP

GPA

Answer in this column

Education

# of Credits Completed

Name of High School/Previous College

Current Year and Current School Name

Please indicate pre-nursing/generic/accelerated/RN to BSN

Answer in this column

Answer in this column

CUNY ID

Eligibility

Are you a U.S. Citizen

Please indicate which ethnic group/s you identify with: Hispanic/Latino or Non-Hispanic Latino

What is your country of birth?

Have you been accepted into Hunter College?

How did you hear about the BEST program?

Have you submitted a 2015/2016 FAFSA?

Do you receive financial support from a parent or guardian? Please specify

Are you receiving financial aid? Please specify

Are you environmentally or economically disadvantaged?

Are you a veteran?

As a BEST Scholar, you will be expected to participate in scholarly activities. Please choose one of the following areas you are most interested in:

Service/Writing for Publication/Research Assistance

Self – Identification :

Pg. 251 of “Performance Report for Grants and Cooperative Agreements” -

Race according to standards for the classification of federal data on race and ethnicity from OMB, five minimum categories on race exist: American Indian or Alaska Native, Asian, Black or African-American, Native Hawaiian or

Other Pacific Islander, and White. The minimum categories for data on race and ethnicity for Federal statistics, program administrative reporting, and civil rights compliance reporting are defined as follows:

Please indicate with which of the following groups you would identify yourself (only choose one):

American Indian or Alaska Native . A person having origins in any of the original peoples of North and South

America (including Central America), and who maintains tribal affiliation or community attachment.

Asian . A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent, including Cambodia, China, India, Japan, Korea,

Malaysia, Pakistan, the Philippine Islands, Thailand, and

Vietnam.

Please Specify Country:_______________________

Black or African-American . A person having origins in any of the Black racial groups of Africa. Terms such as

“Haitian” or “Negro” can be used in addition to “Black or

African-American.”

Native Hawaiian or Other Pacific Islander . A person having origins in any of the original peoples of Hawaii,

Guam, Samoa, or other Pacific Islands.

White . A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

(Please see the third page of this application for further information on race, ethnicity, and underrepresented populations)

Describe why you would like to be a part of the

BEST 4.0 Program (150 words). Please attached a copy of your latest transcript to this application

Jesse Lisnow - BEST 4.0 Assistant Director

Hunter-Bellevue School of Nursing - 425 East 25 th Street New York, NY 10010

(212) 481-6380 jlisnow@hunter.cuny.edu

http://www.hunter.cuny.edu/nursing/current-students/student-support/best-2.0

In order to participate in the BEST 4.0 program, students must be from economically or environmentally disadvantaged backgrounds and must be considered “underrepresented”.

Disadvantaged populations for this award include racial and ethnic minorities underrepresented and individuals who are educationally and economically disadvantaged. Project participants must be in an accredited program, a citizen of the United States, a non-citizen national of the United States, or a foreign national who possesses a visa permitting permanent residence in the United States.

Individuals on temporary or student visas are not eligible participants and may not receive NWD grant support. Definitions for eligibility criteria and how the eligibility is determined are detailed in the funding opportunity announcement (section VIII):

“Economically Disadvantaged” means an individual who comes from a family with an annual income below a level based on lowincome thresholds according to family size published by the

U.S. Bureau of Census, adjusted annually for changes in the Consumer Price Index, and adjusted by the Secretary for use in all health professions programs. The Secretary will annually publish these income levels in the Federal Register. The table below provides a breakdown of family income levels used to determine economic disadvantaged status. Family income is defined as the income of the family of the individual participant or of the family of the parents of the individual participant.

“Educationally Disadvantaged” means an individual who comes from an environment that has hindered the individual in obtaining the knowledge, skills and abilities required to enroll in and graduate from a health professions school. The following are provided as examples of “Educationally Disadvantaged” for guidance only and are not intended to be all-inclusive. Applicants should seek guidance from their educational institution as to how “Educationally Disadvantaged” is defined by their institution.

“Racial and Ethnic Minority Group” means American Indians (including Alaska Natives, Eskimos, and Aleuts); Asian Americans;

Native Hawaiians and other Pacific Islanders; Blacks; and Hispanics.

“Underrepresented Minorities” means racial and ethnic populations that are underrepresented in the registered nurse population relative to the number of individuals who are members of the population involved. Underrepresented minorities include Black or

African Americans, Hispanic or Latino, American Indian or Alaska Native, and any Asian or Pacific Islander group other than

Chinese, Filipino, Japanese, Korean, Asian Indian or Thai.

In accordance with the Funding Opportunity Announcement HRSA-14-069 the criteria listed in your email refers to the criteria for

NWD program participants. All students participating in NWD activities should be disadvantaged in accordance with the definitions listed above. Students identifying with Chinese are included in as Racial and Ethnic Minority, but are not considered

Underrepresented Minorities. This also includes students who identify with more than one race, are not considered Underrepresented

Minorities. Please keep in mind as stated above ALL NWD program participants should be disadvantaged and US Citizens. I hope this answers your question.

I, (print name) _______________________________________________________come from an economically and/or environmentally disadvantaged background.

(Signature)___________________________________________________________

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