Graduate Nursing Scholarship Application Form by zbq75259


									                          Graduate Nursing Scholarship Application Form
I am applying for the following scholarships (check all that apply):
 Trust Graduate Nursing                                         ARNNL 50th Anniversary
 Marcella Linehan                                               Bay St. George Chapter
A. Personal Information (Please Print)
Name:                                                Address:                                                        (street)

Phone:                                               (H)

                                                     (W)                                                             (city/town)

E-Mail:                                                                             (prov)                           (postal code)

ARNNL Registration Number:                                 Social Insurance Number:
                                                                                                (required for income tax purposes)
How long have you resided in NL?                     years

Do you currently reside in the Bay St. George area of NL?                    Yes                 No
If yes, how long have you resided in the area?                                years

Are you a graduate of the General Hospital School of Nursing, St. John’s, NL?                          Yes                 No
If yes, when did you graduate?
                                                                 

Have you previously received a Trust scholarship or bursary?                        Yes                     No

If yes, please specify award(s) and date(s):

B.   School Information
School:                                                                   Program:                  Masters  Doctorate

Current Enrollment Status:      Full Time                      Number of Courses:             Completed:
                                Part Time                                                     To be Completed:
                                                                                               Currently Enrolled:
Program year:             1              2               3                      4+
Please provide the following information about your Dissertation or Clinical Project:                    Click here if N/A
Phase:              Proposal                     Data Collection
                    Report Writing               Other (specify):
Estimated timeframe for completion:

                               APPLICATIONS ARE NOT ACCEPTED BY FAX
C. Education
List any post-basic education you have completed. Include degree programs (e.g., BN, MN) and relevant diploma
or certificate programs (e.g., specialty certification). List the most recent first.
              Institution                             Diploma/Certificate/Degree                             Date

D. Work Experience
Please list your work experience, starting with the most recent.
          Employer                               Position                        Area/Specialty                Date

E. Extracurricular Activities

Are you a member of a Nursing Special Interest Group?                 Yes                No
If yes, please specify:

       Special Interest Group                     Position Held (if any)                              Date

Please list any work related activities in which you participate (e.g., committees, councils, etc.)
      Association/Organization                              Position Held (if any)                           Date
Please list any community or volunteer groups or activities in which you participate.
      Association/Organization                          Position Held (if any)                           Date

F. Achievements
Please list any awards or honours you have achieved. For academic achievements, please include post-secondary
level ONLY.
                                     Award/Honour                                                        Date

G. Financial Assistance
List any financial assistance and amount received for this academic year (e.g., scholarships, bursaries, grants)

   Type of Assistance                              Funding Source                                    Amount
H. Personal Statement
Please provide a brief statement about your professional career plans that addresses your commitment to nursing
(maximum 500 words)
I. Reference
Please supply one reference from a nursing faculty member from your current program who can indicate your
academic ability and potential for contributions to nursing. A reference from your thesis/clinical project supervisor
is preferred.

If you are unable to provide a reference from a faculty member in your current program, you may use someone
from your previous academic program (e.g., BN or MN). References from nursing colleagues will not be accepted.

The reference form is available on the Trust website.

You must provide the referee with your ARNNL Registration Number.

A reference has been requested from:

Name                                    Position                                   Organization

J. Supporting Documentation
Please see the Application and Supporting Documentation Requirements document for a list of documents that
must be received by the application deadline in order for your application to be considered complete.

K. Declaration
By submitting this application, I acknowledge the following:
I have read the scholarship/bursary eligibility criteria and the entire application form.

I have provided information that, to the best of my knowledge, is complete, true and accurate. I understand
that failure to provide complete, true and accurate information may prevent my receiving a scholarship/bursary
now or in the future.

If any of the information provided should change, I understand that it is my responsibility to notify the Trust of
the changes.

I authorize the Trust to use my name for publicity purposes regarding the recipients.

Signature                                                                          Date

                             Late or incomplete applications will not be accepted.

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