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  5. AP BSN Nurse Excellence Scholarship Application
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This form constitutes an application for the University of Texas at Arlington (UTACON) AP BSN Nurse Excellence Scholarship.

Please complete this form only if it is your intention to formally apply for this scholarship.
 
 
 
Contact Information
 
 
Contact Information
* First Name : 
* Last Name : 
* Address 1 : 
   Address 2 : 
* City : 
* State : 
* Zip : 
* Phone : 
* Email Address : 
 
 
 
Previous Degree Information
 
 
 
Please check the degrees you have previously received (please check all that apply).
 
Bachelor's
 
Master's
 
None

 
 
 
What is your (non-degree) GPA?
   
 
 
 
Previous Degree Information
 
 
 
Your Bachelor's Degree
 
 
 
Name of the institution where you received your Bachelor's Degree:
   
 
 
 
Major:
   
 
 
 
GPA:
   
 
 
 
Your Master's Degree
 
 
 
Name of the institution where you received your Master's Degree:
   
 
 
 
Major:
   
 
 
 
GPA:
   
 
 
 
THR Employment Status
 
 
 
Please select the item that best describes you:
 
Not a THR employee
 
THR Volunteer or Joint Venture
 
Employee - Ineligible for benefits
 
Employee - benefit eligible with exhausted tuition reimbursement funds
 
Employee - benefit eligible with tuition reimbursement funds available
 
 
 
Transportation
 
 
 
If accepted as a student for the THR AP BSN cohort you must have a reliable source of transportation to various THR facilities for clinical instruction. (Note: some facilities may not be easily accessible via public transportation.)

Do you have a reliable source of transportation?
 
Yes
 
No
 
 
 
Key Terms of the Scholarship
 
 
 
By submitting this application, I understand that IF I am accepted as a student to the THR AP BSN cohort I will sign a two year work agreement. I understand that statements on this application are true and correct and hereby grant Texas Health Resources permission to verify such answers. I acknowledge and understand that any false statement or omission may be considered sufficient cause for rejection of this application or for program dismissal, if such false statement or omission is discovered subsequent to my acceptance into the program.

 
 
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