FutureCare NC Nursing Student Scholarship Application Question Title * 1. Applicant Contact Information Name Facility Address Address 2 City/Town State/Province ZIP/Postal Code Email Address Phone Number Question Title * 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. Question Title * 3. Are you currently accepted into a nursing program? Yes No Question Title * 4. If the answer to question #2 is "Yes", what is the name of the program? Question Title * 5. If the answer to question #2 is "yes", are you enrolled in year one or year two? Year One Year two Question Title * 6. Have you been employed at a North Carolina Health Care Facilities Association member facility for at least nine months? Yes No Question Title * 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 Question Title * 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 Done