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Bursary Application for RN
Name of Applicant
Date of Birth (MM/DD/YYYY):
Address:
City: Province: Postal Code:
Home Telephone: Cell: Work:
Name of Employer:
Employer Address: Tel ephone:
Email:
Confirmation that applicant is registered for CAET Enterostomal Therapy Nursing Program (ETNEP) with the intention of
continuing or pursuing a career as an ET: YES NO If no, please explain
Resume attached citing educational and work experience: YES NO If no, please explain
You will require two (2) References: (**Must be other than a family member)
Reference #1:
Name: Telephone: Rel ationship:
Reference #2:
Name: Telephone: Rel ationship:



This application is to encourage Registered Nurses to pursue a career in Enterostomal Therapy
_________________________________________________________
Signature
__________________
Date:
ESSAY: In 500 words, please explain your objectives in receiving a grant from United Ostomy Association of Canada

Please refer to the Bursary Criteria for more informaton:
Applicaton deadline: It is the responsibility of the applicant to ensure that all relevant informaton is
received by November 1, 2014.
Please send completed applicaton forms to:
United Ostomy Associaton of Canada
Atenton: Bursary Committee
344 Bloor St. West, Suite 501
Toronto, ON M5S 3A7