Note: Please fill out this form completely and affix all requested attachments when applying. Only one application is necessary to be considered for the available scholarships. Please notify the Office of Student Services for the College of Nursing of any changes in personal information after form submission.

I am enrolled or have been accepted into the following program:

It is very important that you have filed a FAFSA for the 2018-2019 academic year. The majority of College of Nursing Scholarships require documented financial need. Contact the ETSU Financial Aid Office if you have questions about the FAFSA.

The following must be attached to your application:

A current resume including:

• Education
• Employment History
• Awards
• Professional, Academic, and/or student organizational membership
• Community Service Activity

Be certain to include your name in the saved file name i.e., john_doe_resume.doc

I hereby represent, warrant,and affirm under penalty of perjury that all information in this application istrue and correct to the best of my knowledge and belief. I understand that if atany time in the future I plead guilty or no contest to or am convicted of anoffense under 18 United States Code Section 1033 or a criminal felony asdefined therein that I am required to notify by certified mail all insurancecompanies with whom I am appointed and the department of insurance in each ofthose states.