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Congratulations on your academic achievement. Although your academic record is of primary importance, please take the time to fill out this application, which will allow the scholarship committee to know what other qualifications distinguish you as a candidate for a merit scholarship. Please complete and mail or deliver in person the application to the Educational Foundation Office by MONDAY, JULY 2, 2012. THE DSLCC EDUCATIONAL FOUNDATION OFFICE WILL NOT CONSIDER LATE APPLICATIONS! For more information, contact the Foundation Office at 540/863-2837.
YOU MUST ENSURE THAT YOUR APPLICATION, ALONG WITH YOUR OFFICIAL TRANSCRIPT, TWO LETTERS OF RECOMMENDATION (FROM SOMEONE OTHER THAN FAMILY MEMBERS or DSLCC NURSING FACULTY), AND A SIGNED INFORMATION RELEASE FORM ARE RECEIVED BY THE FOUNDATION OFFICE NO LATER THAN MONDAY, JULY 2, 2012 THE EDUCATIONAL FOUNDATION WILL OBTAIN FROM DSLCC NURSING PROGRAM HEAD DOCUMENTATION SHOWING YOUR CURRICULAR AVERAGE AT THE COMPLETITION OF THE SPRING 2011 SEMESTER.
YOUR APPLICATION MAY BE PRINTED AND DELIVERED IN PERSON OR MAILED TO THE ADDRESS BELOW. |
DABNEY S. LANCASTER COMMUNITY COLLEGE
EDUCATIONAL FOUNDATION, INC.
P.O. BOX 1000
CLIFTON FORGE, VIRGINIA 24422-1000
540-863-2837 OR 540-863-2835
(TOLL-FREE: 877-73DSLCC)
FAX: 540-863-2915
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NAME:
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ADDRESS:
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CITY:
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STATE:
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ZIP:
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HIGH SCHOOL:
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HOME PHONE NUMBER:
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EMAIL ADDRESS:
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SSN:
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HAVE YOU BEEN ACCEPTED INTO THE DSLCC NURSING PROGRAM?
YES
NO |
WILL YOU BE A:
FIRST YEAR NURSING STUDENT (as of July 2, 2012)?
WILL YOU BE A:
SECOND YEAR NURSING STUDENT (as of July 2, 2012)? |
1. EXPLAIN YOUR CAREER GOALS--WHERE DO YOU SEE YOURSELF IN FIVE YEARS?
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In order to publicize the Foundation's scholarship programs and promote DSLCC, this award (along with your name as recipient) will be announced in local news outlets and the DSLCC website. If you do not wish the following information made public, please contact the Foundation office. |
3. LIST ANY EXTRACURRICULAR ACTIVITIES IN WHICH YOU ARE INVOLVED ALONG WITH OFFICES HELD, and HONORS BESTOWED: BE SURE TO INCLUDE YEARS OF PARTICIPATION.
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4. LIST COMMUNITY INVOLVEMENT, JOBS, OR VOLUNTEER WORK. BE SURE TO INCLUDE YEARS OF PARTICIPATION, OFFICES HELD and HONORS BESTOWED:
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PARENT'S/GUARDIAN'S NAMES:(if applicable, for news release only)
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SPOUSE'S AND/OR CHILDREN'S NAMES: (if applicable, for news release only)
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NEWSPAPERS IN WHICH YOU WOULD LIKE YOUR NEWS RELEASE PUBLISHED:
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NOTE: SCHOLARSHIP AWARDS WILL BE ANNOUNCED AT THE CAPPING AND PINNING CEREMONY. |
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