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Application for Nursing Scholarship

Sponsored by

New Hampshire Chapter of the

American College of Emergency Physicians

Purpose: to show NHACEP support for quality education in Nursing studies in New Hampshire

Amount: $500.00 award

Criteria for Application:

	You must be enrolled in a fully accredited NH degree program as a nursing student full-time or part-time (6 or more credit hours per semester)
	NH resident for 3 years
	High school or current(freshman) transcript
	Two letters of recommendation
	Active class participation
	Completed application

Due Date: June 1^st preceding the academic year requested.

Please send to: Joy Potter

NHACEP

7 North State St

Concord NH 03301

APPLICANT INFORMATION (Please Print)

_______________________________ ____ ____________________________________

First Name Int. Last Name

____________________________________________________________________________

Street Address and Box Number

__________________________________ _________________________ ___________

City State Zip Code

Telephone Number (_____) ________-____________ Date of Birth ______/_______/_______

New Hampshire Residency Status;

Is the applicant a legal resident of New Hampshire? [ ] Yes [ ] No

If yes, since ___________ / ___________/__________

Month Day Year

ENROLLMENT INFORMATION

Name of School or College you are attending:

________________________________________________________________________

Print the full name of the school or college

___________________________ ___________________ ___________________

City State Zip Code

Anticipated Graduation Date:_________________________________

APPLICANTS' GOALS: (may use a separate sheet of paper if needed)

Why do you want to be a nurse? _______________________________________

____________________________________________________________

What qualities and special skills do you believe you bring to nursing? _________________________________________________________________________

____________________________________________________________

What are your professional goals? ____________________________________________________________

____________________________________________________________

Where do you see yourself in nursing in five years time?

____________________________________________________________

Application for Paramedic Scholarship

Sponsored by

New Hampshire Chapter of the

American College of Emergency Physicians

Purpose: to show NHACEP support for quality education in Paramedic studies and pre-hospital education in NH.

Amount: $500.00 award

Criteria for Application:

You must be enrolled in a fully accredited NH Associates degree program as a Paramedic student full-time or part-time (6 or more credit hours per semester)

	NH resident for 3 year (military service excepted)
	Grade point average of 3.2 or higher (enclose transcript)
	Two letters of recommendation
	Active class participation, exhibiting compassion, respect, leadership and solid interpersonal skills
	Completed application

Due Date: April 15th preceding the academic year requested.

Please send to: Joy Potter

NHACEP

7 North State St

Concord NH 03301

APPLICANT INFORMATION (Please Print)

_______________________________ ____ ____________________________________

First Name Int. Last Name

____________________________________________________________________________

Street Address and Box Number

__________________________________ _________________________ ___________

City State Zip Code

Telephone Number (_____) ________-____________ Date of Birth ______/_______/_______

New Hampshire Residency Status;

Is the applicant a legal resident of New Hampshire? [ ] Yes [ ] No

If yes, since ___________ / ___________/__________

Month Day Year

Military Service _______________________________________________________________

ENROLLMENT INFORMATION

Name of School or College you are attending:

________________________________________________________________________

Print the full name of the school or college

___________________________ ___________________ ___________________

City State Zip Code

Anticipated Graduation Date:_________________________________

APPLICANTS' GOALS: (may use a separate sheet of paper if needed)

Why do you want to be a Paramedic? ____________________________________________________________

____________________________________________________________

What qualities and special skills do you believe you bring to Emergency Medical Services?

____________________________________________________________

What are your professional goals? ____________________________________________________________

____________________________________________________________

Where do you see yourself in Emergency Medical Services in five years time?

____________________________________________________________