Chi Eta Phi Sorority, Inc., Gamma Chi Chapter

A Professional Nursing Organization

Reference Form

Minority Nurse Scholarships




Please complete this section and give this form to your supporting person.


Applicant’s Name: ______________________________________________________________

                                           (First)                                           (MI)                                                     (Last)


Classification:             ____ junior          _____Senior


THE ABOVE NAMED INDIVIDUAL IS APPLYING FOR a scholarship from Gamma Chi Chapter, Chi Eta Phi Sorority, Incorporated.  Please response as requested below.

                                                                                                              Gamma Chi Scholarship Committee


How long have you known the applicant? ________________.





























Please write a brief narrative proving information relevant to the student’s application for this award.  Attach a free for or use the back of this page.  Send directly to: Chi Eta Phi Sorority, Inc., Gamma Chi Chapter.  Attn:  Scholarship Committee 3032 Briarcliff Road, Decatur, GA. 30329-2655.


Your Name __________________________________________ Relationship ______________________


Address __________________________________________________________ City/State________________________________


Home Phone________________________________ Cell_________________________________




________________________________________________________________________________________________       _______________________________________________________________________

                               Signature                                                                      Date