SCHOLARSHIP APPLICATION Page 1 of 5
DEMOGRAPHICS SHEET
Name:
Professional Credentials:
(i.e. RN, AGACNP, FNP,)
Current Population of Study:
(i.e. FNP, AGACNP, Psych, etc)
Current Degree Program:
(i.e. MSN, DNP MSN-DNP)
RN License Number:
HANP Member Number:
Telephone Number:
E-mail Address:
The scholarship application is graded blindly. This is the only page that will have your complete information.
Please place your RN license number on the bottom of every page on your application.
Proof of Academic Enrollment
Please ask your program director to write a letter (preferably utilizing your institution’s letterhead) that states:
1. You are a CURRENT student in an Advanced Practice Program
2. Your current GPA
3. Your RN license number
4. Please send scanned letter along with your application.
Professional Education
Please list your education including the institution, location, degree/diploma and date of completion.
Honors/Awards
If applicable, list your top three significant honors/awards received after completion of your undergraduate nursing program.
Professional Nursing Experience
Please list your professional nursing experience
Professional Contributions
If applicable, please list your top four professional presentations (lectures, poster presentation, publication, research activities, etc.).
Professional Organizations
Please list your participation in nursing organizations and include your contributions and examples of leadership or if you have are involved in committees, etc.
Community Engagement
If applicable, please list any volunteer activities in the last 5 years.
Scholarship Essay
In 250 words or less, please write an essay that includes a response to the questions listed below:
1. What is your professional goal and how does this goal align with the profession?
2. Where do you see yourself professionally in 3 years?
3. How will this scholarship assist you in achieving your stated goal?
RN License Number: ________________________