ANNA JERSEY NORTH CHAPTER 126
APPLICATION FOR SCHOLARSHIP
Scholarships provide funding for continuing education and the development or support of an existing program or innovation to improve patient outcomes. This funding enables nephrology nurses to grow and better contribute their talents to the nephrology community. Please review this application form carefully before completion.
For further information contact: Arlene Paquet RN, BSN, CNN Chapter President at .
Applicants Name______Credentials______
Title______Email______
Home Address______
Telephone (day)______(evening)______
ANNA Membership Expiration Date______Preferred Mailing address ___Home ___Work
APPLICATION DEADLINE: Must be postmarked by August 1, 2006
Fax copies will not be accepted. Any monies awarded are subject to taxation
Please note incomplete applications will not be considered
General Instructions______
1. Please use additional paper, 81/2” x 11” only, to provide the letter of application, relating to specific criteria for scholarship and reasons for applying.
2. Submit typed copy only.
3. Recipients will be required to sign an agreement for use of the funds as established by ANNA.
4. Recipient assumes all tax liabilities associated with the receipt of these funds.
5. All information is strictly confidential and will not be returned, Please furnish proper documentation and ensure that the information presented in your application can be verified independently by ANNA.
Application Completion Instructions______
Completed application form consists of:
1. One copy of the completed application cover sheet entitled, “Application for Scholarship”.
2. One copy of the letter of application (as stated above).
3. One copy of supporting documents that are required for the scholarship such as, transcripts form undergraduate and/or graduate programs that you are currently enrolled
4. One letter from current employer stating your roll as an employee in Nephrology Nursing.
5. Recommendation forms must be given to recommenders to be filled out and sent directly by to ANNA Jersey North President. Letters of recommendation that are attached to the application will NOT be reviewed. They must be mailed separately.
Completed applications should be mailed to:
Arlene Paquet RN, BSN, CNN
The Valley Hospital Renal Care Center
18-01 Pollitt Drive
Fairlawn, NJ 07410