Iowa Society Of Perianesthesia Nurses

National Conference Scholarship Application

Name: ______

Credentials: ______

Rn license number:______

Aspan member number: ______

Home address: ______

City: ______State: ______Zip: ______

Home phone number: ______

Work phone number: ______

Preferred e-mail: ______

Employer: ______

Address: ______

City: ______State: ______Zip: ______

Position: ______

Years in perianesthesia nursing: ______

Certifications: (circle)

CPAN CAPABOTHOTHER

(please provide copies of certification cards)

______

SignatureDate

Scholarship purpose:to promote the involvement of a current ispan member in the activities of the component. The scholarship is intended to:

  • defray attendance expenses at the aspan national conference
  • provide networking opportunities with professional colleagues at a national, regional and state levelduring attendance at the conference
  • introduce recipient to the organizational structure and function of aspan/ispan through participation at various events at the conference.

Prerequisites

  • Current RN license
  • Current ASPAN/ISPAN member for a minimum of 1 year.
  • Past or current employment in a perianesthesia setting
  • Completed willingness to participate form to accompany application

Scholarship recipient must write and submit suitable article in the ISPAN newsletter, Awakening News, within 6 months following conference.

Other considerations:

Attendance at previous ASPAN conference. Year______(submit copy of certificate)

ASPAN activities. Explain:______

Attendance at anISPAN Fall Conference. Year______(submit copy of ceu certificate)

Attendance at ISPAN business meetings. Date(s)______

Participation on an ISPAN ADHOC committee ______

Publication of article in journal/newsletter. Article title and date(s) ofpublication______

New member recruitment. YES NO number______

Poster presentation at aspan/ispan conference. Date:______

CAPA/CPAN certification coach YES NO

Short bio. May include information about professional experience, educational level, personal goals and achievements as related to perianesthesia nursing.

Policy: Component Scholarship To ASPAN National Conference

Purpose: provides guidelines for awarding scholarships to the aspan national conference to be awarded to a current ispan member.

Policy Statement:

1. Applicant must be a current aspan/ispan member for 1 year. Duesmust be current. Information will be verified by the scholarship committee and treasurer.

2. The money will be awarded by dispersing one/half the amount in january. The other one/ half will be dispersed after the conference when the recipient submits receipts and attendance certificate copies to the ispan treasurer.

3. Only activities earned within 1-year of the application date will beconsidered.

4. Scholarship recipients must wait 3 years before they are eligible to reapply.

5. Current members of the ispan board of directors and those receiving funding from ispan for aspan national conferenceattendance are ineligible.

6. The ispan board has the exclusive right to:

A. Determine/approve the monies available for the scholarship amount.

B. Determine the recipient once all application forms have been reviewed. The president will notify the awardee and announce at the january meeting.

7. If the recipient is unable to attend,all monies shall be returned to ISPAN within 2 weeks of cancellation. The person who qualified in second place would be notified.

8. Recipients must submit a brief article(350 words about his/her experience) to publish in the ISPAN newsletter