*Required fields

If you see this don't fill out this input box.

First Name *

Middle Name *

If no middle name, enter "None".

Last Name *

USC ID - This is a nine digit identifier starting with a letter. You can find it at https://my.sc.edu/apps/id/index. Otherwise enter "pending" if you do not have an assigned USC ID. *

Gender *

Please Select Female Male No Response

Race *

Please Select African American AsianPacific Islander Hispanic Native AmericanIndian CaucasianWhite Two or More Races No Response

Email Address (USC Preferred) *

Phone Number *

Permanent Street Address *

Permanent City *

Permanent County *

Permanent State *

Permanent Zip Code *

Please enter your five digit zip code in the following format: 08004

Are you a U.S. Citizen? *

YesNoNo, but I possess a Visa permitting U.S. residency

Are you a SC resident? *

YesNo

Are you a first-generation college student? *

YesNo

What is your military status? *

ActiveVeteranNot applicable

Estimated personal income per year *

Estimated spouse income per year

Estimated parent(s) income per year

Estimated other income per year

Optional - Explain other income

Are you currently receiving any other financial aid? *

YesNo

Do you anticipate receiving any other financial aid in 2020-2021? *

YesNo

List any grants/loans/scholarships you anticipate receiving. *

If you do not anticipate receiving grants/loans/scholarship, please enter "none".

List the total amount of aid you anticipate receiving in 2020-2021. *

Please enter "0" if no anticipated aid for 2020-2021.

What type of student will you be in Fall 2020? *

NewContinuing

In what degree program will you be enrolled Fall 2020? *

Master of Science in Nursing (MSN)Post Master Certificate of Graduate Study in Advanced Practice Nursing (CERT)Doctor of Nursing Practice (DNP)Doctor of Philosophy in Nursing Science (PhD)

Degree Emphasis *

Adult Gerontology Acute Care Nurse PractitionerFamily Nurse PractitionerNurse Executive LeadershipNursing AdministrationNursing InformaticsPsychiatric Mental Health Nurse PractitionerNot applicable

Level of Preparation (DNP/PhD only) *

BSN preparedMSN preparedMasters prepared (non-nursing field)DNP preparedNot applicable

Projected Graduation Semester

SpringSummerFall

Projected Graduation Year

2020202120222023202420252026

Are you a parent, legal guardian, foster parent, or adoptive parent? *

YesNo

Are you a single parent? *

YesNo

Applicant is a resident of *

Union County,SCKershaw County,SCSpringfield County,SCNot applicable

Applicant was *

born and raised in Richland County, SCborn and raised in Lexington County,SCa resident of Carolina Childrens HomeNot applicable

Applicant intends to work with *

Substance abuse research-no experienceSubstance abuse research with experienceAlcohol abuse research-no experienceAlcohol abuse research with experienceAIDSHIV research-no experienceAIDSHIV research with experienceOncology research-no experienceOncology research with experienceNot applicable

Do you plan for your research or practice to focus on women and children’s health? *

YesNo

Are you currently an RN working in Critical Care Nursing? *

YesNo

Applicant is a member of *

Any chapter of Sigma Tau International Honor SocietyAlpha Xi Chapter of Sigma Theta Tau International Honor SocietyAmerican Association of Critical Care NursesStudent Nurses Association (SNA)South Carolina Nurses Association-Any ChapterSouth Carolina Nurses Association-Central Midlands ChapterNot applicable

Will you be enrolled for at least 9 hours for the 2020 Fall Semester? *

YesNo

Are you an Adult Gerontology Acute Care NP student? *

YesNo

Will you be in your final semester in Fall 2020? *

YesNo

Why do you deserve to receive a scholarship? (100 words or less) *

List an example of your innovation. (100 words max)

Some examples of innovation might include: (1) Students who have solved an artistic, scientific, or technical problem in a new or unusual way; (2) Students who have come up with distinctive solutions to problems faced by their schools, communities, or families; (3) Students who have developed an innovative way to save the environment or improve people's health.

What inspired you to attend graduate school? (30 words or less) *

What are your post-graduation plans/career goals? (30 words or less) *

The college can use my name/award amount in marketing materials *

YesNo

My application information can be released to my scholarship donors. *

YesNo

I am willing to attend an event with award donors. *

YesNo