1

Alabama Chapter of the Association of Rehabilitation Nurses Conference Stipend Application

Applicant Requirements

  • Current and active membership status in the Alabama Chapter of ARN for 12 months or more.
  • Current employment or retirement in health care services related to/in rehabilitation nursing.
  • If received, must provide an article for the chapter newsletter or presentation at a meeting/conference.

Application Process

  • Each question should be answered in detail and based on the listed minimum word criteria
  • Each question has a weighted percentage to assess the applicant’s goals and participation for a score totaling 100%.

Selection/Award Process

  • Scholarship/stipend will only be awarded to applicants who meet the established criteria and obtain a score 75% or more.
  • Scholarship/stipend must be used for the intended conference in which it is awarded.
  • Partial stipend may be awarded as agreed upon by the board and the selection committee.

Deadline for submission for application is no later than:

September 20, 2015

Submit electronically to Dr.Karion Gray Waitesat

Instructions for submission:

  • Save completed application and attached essay responses (page 3 of application) as a Word doc. and send as an attachment
  • In the subject line, indicate “ARN Stipend”

Alabama Chapter ARN Scholarship/Stipend Application

Name: ______

Credentials: ______

Mailing Address______

______

Telephone: (Home) ______(Cell) ______

Email: ______

Professional Organization Involvement

  • Current Member of ARN?
  • Membership ID #______
  • Alabama Chapter(paid member) Yes____ How many years____ No____
  • Current CRRN certification ______Number of years______
  • Describe your involvement in ARN local chapter activities:(to includemeeting attendance in past year, positions and offices held,board member, activities, poster/podium presentations,conference attendance)
  • Describe your involvement in ARN regional activities: (to include meeting attendance in past 6 years, positions and offices held, board member, activities, poster/podium presentations, conference attendance)
  • Describe your involvement in ARN national activities: (to include meeting attendance in past 5 years, positions and offices held, board member, activities, poster/podium presentationsconference attendance)

Benefits of Conference Attendance

  • Describe in detail (in an attached document)how your attendance at the conference will benefit the Alabama Chapter of ARNin a minimum of 200 words.

Commitment to Rehabilitation Nursing, nursing profession, and/or to your particular nursing specialty

  • Describe (in an attached document) your commitment to rehabilitation nursing, nursing profession, and/or to your particular nursing specialtyin a minimum of 200 words.

Other professional nursing activities and/or community involvement

  • Describe (in an attached document) your commitment to other nursing activities, the nursing profession, and/or to your other particular nursing specialty interestin a minimum of 200 words.

.Signature of the Applicant

By signing below I certify that I have met the eligibility requirements to receive the Alabama Chapter ARN Scholarship Stipend and agree to participate in the activities outlined in the description of the award.

(Type or print name of applicant)

Please review this application form carefully before completion. For further information, contact theAlabama Chapter of the Association of Rehabilitation Nursesat 8