Adam Brotman Legacy Scholarship Application

Please enable JavaScript in your browser to complete this form.

Name *

First

Last

Preferred Name (If Different Than Above)

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Type of nursing program you are enrolled in *

School You Attend *

I have at least one year left of my nursing program *

Membership is Required for for the Scholarship.

You Must Also Attend One Membership Meeting and Two Volunteer Events

Are you an SDAMN Member? *

Membership Meeting Attended *

Date

Volunteer Event #1 *

Date

Volunteer Event #2 *

Date

Additional Community Service or Leadership

Do you have any additional community service or leadership experience? *

For Example: Community Service & Youth Programs, Faith-Based & Civic Engagement, Education & Mentorship

Please Upload Documented Proof of Additional Community Service *

Drag & Drop Files, Choose Files to Upload

Not Related to Nursing Associations!
Please attach a letter from supervisor on official letterhead with contact information for verification. Must be a PDF

About You!

Please Share A Brief Introduction.. *

This will be posted on sdamn.org if you are awarded the scholarship.

Are you a non-traditional student? *

Will Nursing be your second career? *

Please Describe How You Are A Non-Traditional Student

200 words maximum! Answers are confidential and will only be used for scholarship scoring

Please Describe Briefly Describe Your Prior Career

200 words maximum! Answers are confidential and will only be used for scholarship scoring

Resume / CV *

Drag & Drop Files, Choose Files to Upload

PDF Format Please name it lastname-firstname-resume

Letter of Rccomendation *

Drag & Drop Files, Choose Files to Upload

PDF Format Please. Please Ensure Your Recommender includes their contact information
Please name it lastname-firstname-LOR

Financial Need

Do you have demonstrable financial need? *

200 words maximum! Answers are confidential and will only be used for scholarship scoring

Please Upload Documentation Here *

Drag & Drop Files, Choose Files to Upload

Please upload documentation here
File must be in PDF format
You may submit a copy of your Financial Aid award letter indicating Pell Grant or CCPG eligibility
or
eligibility notice for any of the following programs:
Cal Grant CalWORKs
or
FAFSA Submission Summary (Specifically the first page showing your Student Aid Index)
* Ensure all documents are clear, legible, and include your full name.

Any Information Shared is for Scholarship Purposes Only and confidentiality will be maintained.

Part 1

Do this first.

To Complete The Essay Portion Please Go to the following Google Doc.

It will open in a new window.

Essay Questions

Follow The Instructions On The Page ...

Part 2

Do this Second

Download your Essay Question Page as a microsoft word .docx file & Upload Below.

File Upload *

Drag & Drop Files, Choose Files to Upload

Only .DOCX will be accepted.

A experience?

By signing below, I certify that the information provided in this form is true, accurate, and complete to the best of my knowledge

Signature *

Clear Signature

Sign to the best of your ability,

Please Type Your Name *

Date / Time *

Date

Time

Todays Date and Time

Membership is Required for for the Scholarship.

Additional Community Service or Leadership

About You!

Financial Need

Part 1

Part 2

By signing below, I certify that the information provided in this form is true, accurate, and complete to the best of my knowledge

Let's Connect!

We would love to hear from you.

Our Partnerships

Partnership Opportunities

Contact Info