ACNL Scholarship Application

ACNL Scholarship Application

Scholarship Leadership Development

ACNL Leadership Scholarship/Fellowship/Grant—In support of leadership excellence, the Association of California Nurse Leaders (ACNL) sponsors academic scholarships and fellowships annually for ACNL members.

1) Academic scholarships are awarded to nurse leaders pursuing graduate degrees in nursing or fields supporting health care leadership (i.e. MN, MSN, MBA, MPH, DNSc, DNP, PhD).

2) Leadership fellowships are awarded to nurse leaders who may or may not have an advanced degree, but who are interested in pursuing concentrated studies in an area of health care that will enhance leadership skills such as AONE Center for Nursing Leadership Program, Premiere Healthcare Executive Fellowship at Kellogg Business School or Legislative Internships.

Please note—pre-licensure students may apply for scholarships through the California Nursing Students' Association (CNSA) at

ACNL Research Scholarship—ACNL will award an academic scholarship to a graduate student conducting a research project as part of their academic degree. The scholarship would help fund their research expenses.

Selection is determined through a committee process and is based upon the applicant meeting eligibility criteria, completion of the application documents, and available funds (minimum $500 per awardee).

Scholarships are awarded based on dollars available in the scholarship fund and the number of individuals who have applied. In addition, scholarship recipients are invited to the Annual Program (tuition covered by ACNL) where the award is presented.

ELIGIBILITY

All applicants must:

Be an ACNL member in good standing. If not a member, a membership application must be submitted with Scholarship application. Exception—non ACNL members will be considered for the Research Scholarship, although preference will be given to ACNL members.

Scholarship applicants must:

Be enrolled at least halftime in a graduate degree program in nursing or health care leadership. Applicant may must be enrolled or graduated from an accredited graduate program with the past six (6) months.

Present evidence of satisfactory academic standing

Leadership Fellowship applicants must:

Be accepted into and present evidence of a leadership program or special study program that supports the advancement of the individual as a nurse leader.

Indicate all previous or current scholarship awards received.

Previous ACNL scholarship recipients are not eligible.
If you have questions, contact Wendy Smolich at 916-779-6949 or e-mail:

Association of California Nurse Leaders
Scholarship Leadership Development

Instructions for application

Complete General Information page (parts A.0 through A.6) and sign and date form.

Complete Professional Information pages

Recommendation Letter(s)
Please provide the Recommendation Letter pages to the person(s) you select to provide a letter of recommendation. Include your name in the space provided.
The person you select should be someone you currently work with in a collegial or administrative capacity. They should be able to address your potential to be a successful student demonstrating the qualities listed. They should also comment on your willingness to be a role model for the profession of nursing

Personal message should include what your unique contribution to the profession will be as a result of earning your graduate degree. Message should be no more than 500 words.

Review Checklist to be sure all items are complete for application.

Mail, email, or fax the application to:

Wendy Smolich, ACNL Administrative Manager

Email:
Fax: 916-779-6945

Office Number: 916-779-6949

Mailing Address: 2520 Venture Oaks Way #210

Sacramento, CA 95833
Deadline to submit applications is

Friday, November 29, 2016

CHECKLISTDue by November 29, 2016

Use this checklist to ensure that you have completed the process correctly. Please submit the following ACNL Scholarship Application documents.

Completed APPLICATION

Completed PERSONAL STATEMENT- What your unique contribution to the profession will be as a result of earning your graduate degree. Message should be no more than 500 words.

Completed BIO SKETCH

Provide information the RECOMMENDATION LETTER portion to the person(s) selected

Attach transcripts of the most recent educational program, including current GPA

Verify Recommendation Letter, along with accompanying forms, has been sent to the ACNL according to the application instructions.

Congratulations! Checklist is completed. Good Luck!

Please mail, email, or fax the application to:

Wendy Smolich, ACNL Administrative Manager

Email:
Fax: 916-779-6945

Office Number: 916-779-6949

Mailing Address: 2520 Venture Oaks Way #210

Sacramento, CA 95833
Deadline to submit applications is

Friday, November 29, 2016

Scholarship Leadership Application

(Please type. Application must be complete to be considered.)

Part 1: General Information

Section A.0 Indicate Type of Scholarship Application
Academic Leadership Research
Section A.1 Personal Data
Name:
Home Address:
City, State:
Phone (H): / Zip:
E-mail:
Professional Information
Position/Title:
Work Address:
City, State:
Phone (W): / Zip:
Work E-mail:
Section A.2 Educational Data
Name of School: This section could be omitted and use only the information starting on page ___ (Section _____)
Address:
Title of Program:
Date/Degree Certification:
Section A.3 ACNL Membership Data
How many years have you been a member of ACNL? ( ) Non-member
List ACNL Committee/Task Force positions held or check box. ( ) None
Section A.4 Financial Awards Received To Date
Itemize list of provider(s) and amount(s) ( ) None Received
Provider / Amount / Provider / Amount
This Financial Awards section could be omitted and use only the information starting on page ______(Section ____)
Section A.5 Are you working while in school?
( ) Not working / ( ) Part time / ( ) Full time
Section A.6 How will this funding assist you at this time?
I agree to provide follow up information to ACNL for one (1) year.
( ) Yes / ( ) No
Comment:
Signature / Date/Time

Applicant Name: Page 1

ACNL Scholarship Application

B.1 EDUCATION

Provide proof of your highest educational levelattained.

Institution / Location / Field of Study / Degree / MM/YY
1.
2.
3.
4.

Indicate current GPA.: ______

B.2 CERTIFICATION/CREDENTIAL

•Provide proof of any certification credential(s) that you haveachieved.

•Copy of test question acceptanceletter.

Certification or Acceptance Letter / Date Received / Points
1.
2.
3.

B.3 PUBLICATIONS: List recent authored/co-authored publications

Activity / Title / Date / Location / Points
1.
2.
3.
4.
5.
6.
7.
8.
9.

Applicant Name: Page 1

ACNL Scholarship Application

B.4 SPEAKING ENGAGEMENTS / PRESENTATIONS

Activity / Title / Date / Location / Points
1.
2.
3.
4.
5.
6.
7.
8.
9.

B.5 COMMUNITY SERVICE ACTIVITIES

Activity / Position / Dates / Points
1.
2.
3.
4.
5.
6.
7.
8.

Recommendation Letter

NAME OF APPLICANT______

To the Recommender: In writing your letter of recommendation, please address how the applicant demonstrates the qualities listed below. You may use a separate sheet of paper. The instructions for sending this letter are listed below. Please return these pages with your recommendation letter.

Suggested Qualities:

Vision: Describe how this individual creates a vision for their future, the future of the project, organization, association, and/or the profession.

Collaboration: Provide insight into how this individual uses the quality of collaboration to facilitate teamwork and bring a project to completion

Risk Taking: Provide at least one example where this individual stepped out of their comfort zone and took a risk to accomplish a goal or fulfill a vision. What was the impact on the profession of nursing?

Entrepreneurial Spirit: Describe how this individual demonstrates the entrepreneurial spirit to accomplish a goal, make a dream come true, or fulfill a vision. What was the impact on the profession of nursing?

Leadership Ability: Provide one example of this individual’s ability to provide direction, guidance, and visionary thinking. What was the impact on the profession of nursing?

Please indicate the strength of your overall endorsement of this applicant:

Recommenders’ Name: ______

Organization: ______

Position:______

Address: ______

Phone: ______Email: ______

Signature ______Date ______

Please mail, e-mail, or fax your recommendation letter and the this form to:

Wendy Smolich, ACNL Administrative Manager

Email: ax: 916-779-6945

Office Number: 916-779-6949

Mailing Address: 2520 Venture Oaks Way #210

Sacramento, CA 95833

Recommendation Letter

NAME OF APPLICANT______

Suggested Qualities:

Vision: Describe how this individual creates a vision for their future, the future of the project, organization, association, and/or the profession.

Collaboration: Provide insight into how this individual uses the quality of collaboration to facilitate teamwork and bring a project to completion

Leadership Ability: Provide one example of this individual’s ability to provide direction, guidance, and visionary thinking. What was the impact on the profession of nursing?

Please indicate the strength of your overall endorsement of this applicant:

Recommenders’ Name: ______

Organization: ______

Position:______

Address: ______

Phone: ______Email: ______

Signature ______Date ______

Please mail, e-mail, or fax your recommendation letter and the this form to:

Wendy Smolich, ACNL Administrative Manager

Email: ax: 916-779-6945

Office Number: 916-779-6949

Mailing Address: 2520 Venture Oaks Way #210

Sacramento, CA 95833

Applicant Name: Page 1