Rio Colorado Yuma Chapter 7 Arizona Nurses Association Yuma, Arizona Nursing Scholarship Application Rio Colorado Yuma

Chapter 7 of the Arizona Nurses Association (AzNA) provides two scholarships annually to nursing students in the last semester of their nursing program for initial registered nurse licensure, one each in the spring and fall semesters. Additionally, one scholarship is awarded annually during the fall semester to a Yuma County resident Registered Nurse accepted and enrolled in an undergraduate or graduate nursing program. Initial licensure nursing student scholarships total $500.00, a portion of which goes to the awardees first year membership in Chapter 7 of AzNA, following RN licensure, with the remainder being awarded directly to the awardees. The RN continuing education scholarship total is $1000.00, a portion of which goes to membership dues for one year in Chapter 7 of AzNA with the remainder being awarded directly to the awardees. For those continuing education scholarship awardees who are already members of AzNA, the entire scholarship amount is awarded directly to the awardees. Preference is given to those applicants who are already members of the Student Nurses Association of Arizona (SNAAz) or AzNA; however membership is not a requirement. The scholarship requires a minimum two year commitment to practice nursing in Arizona. Application Deadlines: March 15th or Oct. 15th (Initial licensure scholarship only) October 15th (Initial licensure and RN continuing education scholarships) The same application (following pages) is for both the initial licensure and RN continuing education scholarships. Items that do not apply to the applicant should be left blank. Information provided by applicants is confidential and will only be seen by members of the Rio Colorado Chapter 7 scholarship committee. Applications may be requested via e-mail from Leslie Dalton at rossnles@roadrunner.com. Completed applications should be forwarded by mail to: Leslie Dalton, MSN, RN Rio Colorado Chapter 7, AzNA Scholarship Committee 4103 W. 14th Street Yuma, AZ 85364-6047 Applications post-marked after the March 15th deadline will not be considered. Receipt of application will be confirmed by e-mail.

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Rio Colorado Chapter 7 Arizona Nurses Association Yuma, Arizona Nursing Scholarship Application Directions: Please type or print. Date: __ __________ I. PERSONAL INFORMATION Name: __ _____________________________________________________________________ Present Address: ____ ___________________________________________________________ Street _______ ______________________________________________________________________ City, State, Zip Daytime Phone: __________________________Evening Phone: _________________________ Email Address: _________________________________________________________________ Permanent Arizona Resident Since: _________________________________________________ Gender: Female Male Yes No

Are you currently a member of SNA/SNAAz or AzNA?

If so, member number: ____________________________________ Veteran: Yes X No

If currently an RN, license number: _________________________________ Have you ever applied for an AzNA Rio Colorado Chapter 7 Scholarship? If yes, when: __ _______________ Have you ever been awarded an AzNA Rio Colorado Chapter 7 Scholarship? If yes, when: __ ____________________________________ Yes No

Yes No

Have you been awarded any other scholarship assistance at this time? Yes No If yes, please provide total amount: ________________________________________
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II. EDUCATIONAL STATUS* Are you currently enrolled in a program of nursing? Full time Part time What nursing degree are you currently pursuing? Yes No

Associate Degree Bachelor Degree Masters Degree Doctoral Degree

What college or university are you attending? _ _____________________________________ City: ________________________________________

When did you begin the program? __ ______________________________________________ (Month/Year) When are you planning to complete your degree? __ _________________________________ (Month/Year) What is your current Grade Point Average? ___________ *Please have an official copy of your most recent transcript sent directly from the registrars office to the scholarship committee address below to verify GPA. III. FUTURE PLANS Where do you plan on practicing nursing following your graduation? _______ _____________ I intend to practice nursing in Arizona for at least two years after licensure. ______________ Initial ON A SEPARATE PAGE PLEASE ADDRESS THE FOLLOWING AREAS: (Please limit your response to a single typed or printed page.) Describe your future plans and nursing career goals for the next five years; Describe a community service or program in which youve participated in the last two years OR current extracurricular activities which demonstrate your leadership ability; Share your reason for selecting nursing and how you will use your education to make an impact on the community as a healthcare leader; Describe your leadership qualities, outstanding accomplishments, and/or unique talents.

IV. FINANCIAL NEED 3

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Number of dependents and ages: ______________________________________________________________________________ ______________________________________________________________________________ Please explain in the space provided how this scholarship will help you successfully complete your program of study (If additional space is required, please attach an additional sheet to your application. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ____________________________________ V. CURRENT EMPLOYMENT* Are you currently employed? Yes No

Employer: ________________________________________ Position: _ ___________________ Annual Income: __________________ Supervisor: _ ___________________________________ Work Phone: ________________________________ If needed, may we contact your employer? Yes No

If needed, may we contact your employer? Yes

No

*Please attach a recent copy of your curriculum vitae, resume or work portfolio.

VI. REFERENCES You must have three current letters of reference from individuals affiliated with your school and/or professionals in your field of study who are familiar with your academic work and/or

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interest in nursing. Letters of reference should focus on your commitment to nursing and your demonstrated leadership experience(s) and/or potential leadership ability. Please emphasize with each of your reference providers this above dual focus. These letters may be included in your application portfolio; should you decide to create/present one; or may be mailed or hand delivered to: Leslie Dalton, MSN, RN Rio Colorado Chapter 7, AzNA Scholarship Committee 4103 W. 14th Street Yuma, AZ 85364-6047 I certify that this information is accurate to the best of my knowledge. I understand that scholarships are awarded at the discretion of the Rio Colorado Chapter 7 AzNA Scholarship Committee. I hereby give the Committee permission to contact my employer, my school and my references for verification of this information. I understand that I must meet all the criteria in order to be considered. Signature: _______________________________________________ Date: ________________ Return by March. 15th for the spring semester nursing scholarship, or October 15th for the fall semester nursing scholarship or the RN continuing education scholarship to: Leslie Dalton, MSN, RN Rio Colorado Chapter 7, AzNA Scholarship Committee 4103 W. 14th Street Yuma, AZ 85364-6047 Include with this application form: Responses to questions on page 3 curriculum vitae, resume or work portfolio Under separate cover three letters of reference (or included in your portfolio) Verification of grade point average

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