Doris R. Hines Scholarship Application

Application Deadline: March 15, 11:59 p.m.
PURPOSE
The Doris R. Hines Ph.D., RN, CETN Nursing Scholarship provides financial assistance to a Mosaic Life Care nurse pursuing a degree beyond the bachelor's level. To acknowledge and honor a lifetime of excellence in nursing practice, family and friends of the late Dr. Doris Hines established a scholarship in her name through the Mosaic Life Care Foundation.
ESTABLISHING THE SCHOLARSHIP
Mosaic Life Care Foundation is a 501(c)(3) public charity dedicated to championing education and empowering people to build healthy and thriving communities.
CRITERIA
Enrollment in an accredited/approved nursing program above the bachelor's level.
Employment with Mosaic Life Care.
Maintain a 3.0 or higher GPA on a 4.0 scale.
Indicate any prior and current service to humanity or healthcare if applicable.
Provide references and recommendations.
REFERENCE LETTERS
Upload two current letters of recommendation. Each letter must include date of letter, the author’s name, relationship to applicant, professional title of employment and employment place.
Example:
Month/Day/Year
John Smith, Intern Supervisor
Vice-President
ABC Accounting
1234 Elm St.
City, State, Zip
INFORMATION REQUIRED FOR THIS APPLICATION
1. Personal Information

2. Employer Information

3. Narrative Information

4. Transcript

5. Proof of acceptance and full-time enrollment in nursing program

6. Two reference letters
DISQUALIFICATION
Failure to complete and provide a complete application will be automatic disqualification.
PERSONAL INFORMATION
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
County*
Email*
Phone*
EMPLOYER INFORMATION
Are you employed?*
- Yes
- No
Employer*
Length of Service*
Job Title*
Number of hours worked per week:*
Supervisor's Name*
First Last
Supervisor's Phone*
NARRATIVE INFORMATION
Please do not provide personally identifiable information.
Name of institution where you are currently enrolled:*
Number of credit hours:*
Previous semester GPA:*
Cumulative GPA:*
Aside from the financial benefit, why are you applying for this scholarship?*
How will this scholarship enhance your professional and career goals over the next five years?*
What is your prior and current service to humanity and healthcare?*
Define and provide the anticipated program costs (include dollar amounts) and support your need for financial assistance.*
List other monetary funds (financial aid, scholarships, grants) received including dollar amounts.*
Share information related to your work at Mosaic Life Care including: length of service and number of weekly hours, why you chose to be associated with the healthcare related field, how you feel you make Mosaic Life Care a better place.*
List awards or honors received in the last five years.*
List extracurricular activities including community involvement, hobbies and interests within the last five years.*
UPLOADS
Uploaded documents must be in pdf format. Any other format will automatically disqualify the application.
Transcript indicating: cumulative and semester GPA, class rank, scale used*
Max. file size: 500 MB.

Must be in pdf format.
Proof of acceptance and full-time enrollment of an accredited/approved nursing program above the bachelor's level*
Max. file size: 500 MB.

Must be in pdf format.
Please upload Reference Letter 1*
Max. file size: 500 MB.

Must be in pdf format.
Please upload Reference Letter 2*
Max. file size: 500 MB.

Must be in pdf format.
Consent*
In submitting this application, I certify that the information provided is complete and accurate to the best of my knowledge.
Incomplete scholarship applications will not be considered by the committee. Falsification of information may result in termination of any scholarship granted. This application becomes property of the Mosaic Life Care Foundation.