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FutureCare NC Nursing Student Scholarship Application
1.
Applicant Contact Information
Name
Facility
Address
Address 2
City/Town
State/Province
ZIP/Postal Code
Email Address
Phone Number
*
2.
In a 400 - 500-word essay, describe/explain why you want to be a nurse. What would you like or hope to accomplish during your nursing career.
(Required.)
3.
Are you currently accepted into a nursing program?
Yes
No
4.
If the answer to question #2 is "Yes", what is the name of the program?
5.
If the answer to question #2 is "yes", are you enrolled in year one or year two?
Year One
Year two
6.
Have you been employed at a North Carolina Health Care Facilities Association member facility for at least nine months?
Yes
No
7.
Do you agree to remain employed at a North Carolina Health Care Facilities Association member facility for at least 18 months after licensure?
Yes
No
8.
Each scholarship applicant must submit at least three Letters of Recommendation (emailed to
erick@nchcfa.org
) with 2 of the required letters from the applicants SNF Supervisor and a nursing program instructor. Please share with us the names of who will be submitting your Letters of Recommendation.
SNF Supervisor
Program Instructor
Other