Application for Financial Assistance for current students of the U of M School of Nursing
Please complete this application completely. Incomplete information will result in a postponement of a decision or denial of your request.
Date Request submitted
Name:
Student ID number
E-mail Address:
Telephone Number
Local Address:
County
Citizenship
US Citizen
Non US Citizen
Residency
Out of State
In State
Status
Part-time
Full-time
Current GPA
SN Level:
Freshman
Sophmore
Junior
Senior
RN to BSN
2nd Career
Masters
PhD Candidate
Expected date of graduation:
Would you be willing to work in an underserved area after graduation?
yes
no
Are you interested in working in any of the following areas? (check all that apply)
Administration
Geriatrics
Mother/children
Research
Current Employer
Do you receive tuition reimbursement?
yes
no
Amount Requesting
Please explain in detail why you need assistance:
Please attached the completed budget worksheet previously received.
for office use only
Amount Granted
Source
Appointment Date/Time
Notes from Meeting
Indicates Response Required