Smiths Medical Canada Award

Smiths Medical Canada Award

Canadian Association of Critical Care Nurses

Cover Sheet

Name: ______

Printed

Signature: ______

Date: ______

Total of Accumulated Merit Points = ______

(added from all accompanying record sheets)

Included with this application are:

• Completed Personal Information Sheet
• Record Sheet for ______to ______
• All Supporting documentation
• Letter of reference from current employer
• Proof of student status

Smiths Medical Canada Award

Canadian Association of Critical Care Nurses

The CACCN Educational Awards have been established to provide funds ($1000.00 each) to assist critical care nurses to attend continuing education programs at the baccalaureate, masters and doctorate of nursing levels. All critical care nurses in Canada are eligible to apply, except members of the CACCN board of directors.

Criteria for application

1. be an active member of CACCN in good standing for a minimum of one (1) year.
2. demonstrate the equivalent of one (1) full year of recent critical care nursing experience in the year of the application.
3. be an active member (minimum of one [1] year) of CACCN committee(s) and/or participate in other chapter-related activities. Past participation is acceptable.
4. submit a letter of reference from his/her current employer.
5. be accepted to an accredited school of nursing or recognized critical care program of direct relevance to the practice, administration, teaching and research of critical care nursing.
6. incomplete applications will not be considered; quality of application will be a factor in selecting winners.
7. was not the recipient of this award in the past two years.

Application process

1. submit completed CACCN educational award application forms to national office (forms package can be requested from national office).
2. obtain a minimum of 250 merit points over three years (preference will be given to members with the highest number of merit points).
3. keep a record of his/her own merit points, dating back three (3) years (forms included in package).
4. submit all required documentation outlined in criteria - candidate will be disqualified if documentation is not submitted with application.

Post-application process

1. all applications will be acknowledged in writing from the awards committee.
2. unsuccessful applicants will be notified individually by the awards committee.
3. winners will be acknowledged at Dynamics of Critical Care and be published in the official journal.

Smiths Medical Canada Award

Canadian Association of Critical Care Nurses

Record of Merit Points for ______(year)

Please complete one sheet for EACH year of Merit Points being counted.

Supporting documentation MUST be included with submission.

1. Current CACCN Member

• n/a

1. Attendance at Chapter Meetings

• Attendance sheets of meetings attended

1. Recruitment of new members

• Names of new members

1. Attendance at Chapter workshops

• Names of workshops attended

1. Attendance at DYNAMICS

• n/a

1. Executive of CACCN (past national and/or current or past local)

• Positions and dates

1. Speaker at meeting, workshop, conference

• Date, time, place and topic for each presentation

1. CACCN Committee Member (national and/or local)

• Name of Committee and dates involved

1. Liaison link between Chapter and Hospital

• Name of hospitals

1. Completion of recognized post-graduate course in critical care nursing

• Name of each course completed

1. Article published

• Name of article, date and place published

1. Current CNCC(C) OR

• Date and city of certification

Note: if supporting documentation showing accumulated points is NOT included, the entry will be disqualified.

Smiths Medical Canada Award

Canadian Association of Critical Care Nurses

Personal Data

Name:______

Address:______

Telephone:Home ( ) ______Work ( ) ______

E-mail Address:______

Employer:______

Position:______

CACCN #:______Member since: ______

Description of Educational Request

Program of Study:______

School/University:______

Expected Date of Completion: ______

Cost of Tuition/Year:______

Costs: Accommodation ______Transportation ______

Curriculum Vitae

School of Nursing:______Date of Graduation: ______

Diploma/Degree Conferred: ______

Previous Post-Basic Education: ______

______

Nursing Experience: ______

______

Professional Affiliations: ______

______

Involvement with CACCN:

Participation in CACCN: ______

______

Future Contributions: ______