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) (Middle)

Primary Address:

Street

City

State Zip

County
Please answer the following questions relating to your future plans:

1. Attending 4 year college nursing program: □ Yes □ No

2. Attending 2 year nursing program: □ Yes □ 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
Monroe,WI 52566
Certification
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:_______________________