Philippine Nurses Association of San Diego County, Inc.

Instruction:

Fill in the application form and submit the following documents to
PNASD, P.O. Box 881114, San Diego, CA 92168

STUDENT INFORMATION:

1. Name: ______________________________________________________

2. Permanent Mailing Address:

	Address	________________________________________________
	City	________________________________________________

State

_______________________________

Zip

____________

3. Ethnic Background: (circle one)
       a. Filipino
       b. Filipino and other

4. Academic Status: (check one box)
         First (Freshman)
         Second (Sophomore)
         Third (Junior)
         Fourth (Senior)
         Fifth (Undergraduate)
         Graduate Student

5. Name of College/School: _______________________________________

6. Enrollment Status: (circle one)
       a. Full Time
       b. Part Time

7. Submit the following documents with your application:

	a.	A copy of your transcript record
	b.	Letter of recommendation from your Professor/Teacher
	c.	A personal essay describing your short and long term goals, projects, community involvement and why you think you deserve to be the recipient of the scholarship award
	d.	Complete, sign and date the Scholarship Expectation form.

__________________________________________		___________________
Signature		Date