PROVOST’S SCHOLARSHIP FOR
DELMARVA GRADUATE NURSING STUDENTS
APPLICATION FORM
Eligibilty: These scholarships are awarded to residents of Delaware and the
Eastern Shore of Virginia who are matriculated in the graduate Nursing program.
Scholarships are renewable for up to four years as long as the student maintains
good academic standing in the graduate Nursing program.
Amount: Students receive a scholarship which covers approximately 75% of
the tuition differential between in-state and out-of-state charges per credit hour
for each graduate credit hour applied toward their Master's degree in Nursing.
Application: Submit this form to the Director of the Graduate Nursing Program
along with a copy of your latest Delaware or Virginia state income tax return in a
sealed envelope addressed to Alan Selser, Business and Finance, Salisbury
University, Salisbury, MD.
Name: ___________________________________________________________
Address: __________________________________________________________
City:
__________________________________________________________
State: ______________________________ Zip Code: _____________________
Term for which you are applying: ______________________________________
Graduate nursing courses for which you registered: _______________________
_________________________________________________________________
I certify that I am a legal resident of Delaware or of Accomack or North Hampton
County, Virginia.
Signature of student ________________________________________________
This applicant meets the academic requirements for this scholarship.
Signature Graduate Program Director ___________________________________
Program Director: please send this form to Alan Selser, Business and Finance.
7/07
PROVOST’S SCHOLARSHIP FOR
DELMARVA GRADUATE NURSING STUDENTS
RENEWAL FORM
Name:
__________________________________________________________
Address: __________________________________________________________
City:
__________________________________________________________
State:
____________________________ Zip Code: _____________________
Date of initial scholarship: ___________________________________________
Term for which you are renewing: ______________________
Graduate nursing courses for which you registered: _______________________
_________________________________________________________________
Signature of student ________________________________________________
This applicant has good academic standing in the graduate Nursing program.
Signature Graduate Program Director ___________________________________
Program Director: please send this form to Alan Selser, Business and Finance.
7/07