Scholarship Application Scholarship Application Form Scholarship Application Form December Deadline "*" indicates required fields 1Student Info2Education Info3Scholarship Selection4Short Essay Questions Start with the basics!Tell us who you are and how we can get ahold of you. The scholarship application is due December 15, 2023.First Name* Last Name* Phone*Email* Student ID #* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Zip Code Education Details Let us know what you've been learning! Family Size Do you live in a rural community? If yes, list what city and county with population size.Have you completed the Free Application for Federal Student Aid (FAFSA)?YesNoAre you a veteran or on active duty in the U.S. Armed Forces?YesNoDo you receive outside assistance from any organization?YesNoWhat Branch / Rank? Please describe aid and amount received. What program do you plan to attend next semester?*Associate of Science in NursingBachelor of Science in NursingMaster of Science in NursingAssociate of Science in RadiographyBachelor of Science in Diagnostic ImagingMaster of Science in Occupational TherapyMaster of Science in Nutrition Diagnostics & Dietetic InternshipMaster of Science in Nutrition DiagnosticsDietetic InternshipWhat area do you plan to specialize in? Is there a specific track within your program that you are doing? (Example: Sonography) Race / EthnicityAmerican Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhiteTwo or More RacesNo ResponseExpected Graduation Date MM / YYCurrent College GPA (if applicable) Do you have a college degree? If so, please fill in full name of degree and college. Are you a Burge/Cox College Legacy? (Relative of an alum)YesNoName of alum: Time to apply! Check any/all scholarships that you qualify for. No limit.Nursing Scholarships A. P. Stone Scholarship S. Lee Honig Scholarship Richard and Viola Thorp Scholarship R & B Campbell Memorial Scholarship Madge Mills Arthur Scholarship Dr. Max Fitch Memorial Scholarship Burge Alumni Scholarship Tell us a little bit about you!. What impact will a scholarship have on getting your education?*Describe a time that you have gone out of your way to be of service.*Why did you choose this educational path?*How do you see yourself using your degree in service to others in the future?*
