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.
Deadline to submit application/nomination is July 31, 2020. Awardees will be notified by the committee - please ensure contact information is accurate (email and phone number). Awardees will be presented at a ceremony at a date/location TBD.

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 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.