Colonel Janice Mano Lehman Memorial Scholarship

INSTRUCTIONS FOR COMPLETION

Use this form to respond to the Madigan Foundation’s Colonel Janice Mano Lehman Memorial Scholarship.
All required areas must be complete and contain all required documents.

Name of applicant or nominee*
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Address*
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City*
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State*
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Zip Code*
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Email Address*
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Contact Phone*
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Cell Phone
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Status & general background of applicant/nominee*
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Nominated by: (If applicable) Please provide name, relationship to nominee and how long you have known nominee.
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Reason for application or nomination:
Please provide name, dates and location of school, course, conference, research project, or other particular purpose for which a scholarship would be applied.*
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Please attach a one-page narrative describing the applicant/nominee’s individual goals, values, and attributes toward nursing leadership, communication, selfless service, and /or professional growth.
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Financial Factors:
What is the financial cost of your request?*
Please type your full name.

Is the applicant receiving financial support from other organizations or institutions?*
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What is the financial need of the nominee for a scholarship or potential impact if a scholarship is not received?*
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Please provide any other information that you feel the committee needs to know.
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IF SELF NOMINATED, please attach at least two letters of recommendation from someone other than a family member.
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Recommendation 2
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THANK YOU for submitting this application/nomination. Please forward your completed application/nomination NLT (1st Monday in April) to: The Madigan Foundation, PO Box 97215, Lakewood, WA 98497 or online.

Security*
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