Certified in Care Coordination and Transition Management
(CCCTM) Certification Grant

is sponsored by the Medical Surgical Nursing Certification Board (MSNCB)

Deadline:November 15 annually

Grants provide an opportunity for members of the American Academy of Ambulatory Care Nursing (AAACN) to receive funds to cover the exam registration fee to become CCCTM certified. Recipients have one (1) year from the date they are notified that they are recipients to take the exam.

EligibilityCriteria

Certified in Care Coordination and Transition Management (CCCTM) Certification Grant – Sponsored by the Medical Surgical Nursing Certification Board

(Two $255 grants to cover exam fee will be awarded annually)

•Membership in the American Academy of Ambulatory Care Nursing (AAACN) for a minimum of two continuous years at time of application.

•Willingness to give back. e.g. How will you use your enhanced knowledge/certification to contribute back to AAACN and/or ambulatory care nursing?

•Agreement to become certified in Care Coordination and Transition Management within one year of receiving award.

•Currently eligible to sit for the exam.

Certified in Care Coordination and Transition Management (CCCTM) Certification Grant

APPLICATION

You must be a member of AAACN to apply for one of these grants.

Instructions:

All applicants should complete the application, respond to questions, and submit a copy of your resume/CVby the November 15deadline to . Insert “Award/Scholarship Application”in the subject line. Or, mail the application to: AAACN Scholarships, P.O. Box 56, Pitman, New Jersey, 08071-0056. Applications receive a blind review by the Nominating Committee.

Demographic Section:

Name:Credentials:

Job Title:

Employer:

Mailing Address:

E-MailAddress:

Phone Numbers: Home Work

Howlong have you been a member of AAACN?

Are you Nursing certified?

If yes, which one?

AmbulatoryOther

Whatvolunteer committees, task force, etc., have you participated in for AAACN?

Howdo you promote AAACN?

Number of AAACN Conferences attended in the past?

Number of presentations given at AAACN Conference(s), including poster presentations?

Whatis your highest level of education?

ADN_____ RN____ BSN Masters __ Doctorate ___ Other___

Whatis your degree in?

Nursing ___ Business __Health Related Other (please describe):_

Are you a member of any other professional organizations? [ ]Yes [ ] No

If yes, which organizations?

Additional eligibility criteria for Certification Award:

1. I agree to become certified in in Care Coordination and Transition Management within one year of receiving award?

____Yes _____No

2. I am currently eligible to sit for the exam? ____Yes ____No

Narrative:(Use separate sheet if necessary)

Write a brief paragraph explaining how you will use yourenhanced knowledge and certification to contribute back to AAACN and/or ambulatory care Nursing?(50-100 words).

Please provide written description of why certification is important to you (50-100 words).

Please describe your motivation for attaining this certification (50-100 words).

Describe any benefits from your employer such as pay or promotion, requirements of career ladder, professional status, personal/professional satisfaction, or any other motivators. (50-100 words)

Note: Please include your resume/CV with your application

All applicants must sign and submit this page.

Theinformation provided in this application is accurate and complete. I understand that acceptance of an AAACN award, scholarship, or grant obligates me to use the funds awarded for the intent described in this application. I further understand that misuse of AAACN award, scholarship, or grants may result in permanent revocation of my AAACN membership and a requirement that I refund any misused funds to AAACN.

Allinformation contained in this application will be considered confidential and will be reviewed only by members of the Nominating Committee of AAACN and staff. All applications are blinded by staff before they are sent to the Nominating Committee for consideration.

SignatureDate

PleasesubmitapplicationsbyNovember 15to:

Via email to:

Or, mail to:AAACN Scholarships

P.O. Box 56

Pitman, NJ 08071-0056

Overnight:AAACN Scholarships, c/o A. J. Jannetti, Inc.,

200 East Holly Avenue, Sewell, NJ 08080

NOTE: Out of respect to all applicants, incomplete submissions or those submitted after the deadline will not be considered.

M:\AWARDS\2017 Awards\CCCTM Grant_Application.doc

American Academy of Ambulatory Care Nursing CCCTM Certification Grant Application 1