Wilde Monroe High School Scholarship (f)

MICHAEL WILDE NURSING SCHOLARSHIP 2008-2009

On July 2, 2006 Bellin Health, Green Bay, Wisconsin, lost a long-time colleague and a compassionate caregiver when Michael Wilde succumbed to his battle with pancreatic cancer. Mike graduated from Monroe High School in 1975 and from the Bellin College of

Nursing in 1984 and began a 22-year career with Bellin Health. As a bedside nurse and later as a leader in the Bellin Medical Group, Mike contributed much to the lives of patients and their family members and his coworkers. He was dedicated to the core principles and mission of community-based healthcare. In the last few months of his life, Mike expressed a heartfelt desire to establish an endowed scholarship to support the dreams and wishes of young people interested in nursing. With a generous gift from Mike and the overwhelming support of colleagues and friends, the Michael Wilde Nursing Scholarship fund was formed. Each year a scholarship will be awarded to a graduating from Monroe High School who has a demonstrated interest in pursuing an education in nusring. The scholarship amount will vary from year to year. Please type or print. Name: (Last)

(First)

Primary Address: Street City State County

Zip

(Middle)

Please answer the following questions relating to your future plans: 1. Attending 4 year college nursing program: 2. Attending 2 year nursing program: □ Yes

□ Yes

□ No

□ No

3. Attending 2 year program in the nursing field: Program: _______________________ The Michael Wilde Nursing Scholarship is not fully need-based, however, it is

recommended that you file a 2008-2009 Free Application for Federal Student Aid

(FAFSA) .

Monroe High School will use the information you supplied on this application form as well as other data on file to determine The Michael Wilde Nursing Scholarship award. By signing this form, you agree to allow the Monroe High School scholarship reviewer(s) to access this information for the purpose of determining The Michael Wilde Nursing Scholarship award. Please submit completed application form to Laurie Plourde by February 24,

applications received or postmarked after this date will not be considered. Mail to:

Monroe High School Laurie Plourde 1600 26th Street

Certification

Monroe,WI 52566

I hereby certify that all information submitted by me is true and accurate to the best of my knowledge. I understand that all scholarship decisions made by the

scholarship reviewer(s) at Monroe High School are final. I further understand that should I fail to enroll in a Nursing Program as indicated above, I will forfeit the award. Signature:__________________________ Date:_______________________