R.N./LPN SCHOLARSHIP APPLICATION FOR LONG-TERM CARE

Transcription

1 R.N./LPN SCHOLARSHIP APPLICATION FOR LONG-TERM CARE To assist qualifi ed persons who wish to become registered nurses or licensed practical nurses and practice in the long-term care profession, Health Care Information Systems, The Vetter Foundation, and the Nebraska Health Care Foundation, Inc., will award four (4) $1,000 R.N. scholarships and four (4) $750 LPN scholarships at the 2014 Nebraska Nursing Facility Association/ Nebraska Assisted Living Association Spring Convention in Kearney. Persons eligible to apply for a scholarship must: 1. Be enrolled or eligible to enroll in a R.N. or LPN School of Nursing for the school year. 2. Be presently employed in a NNFA/NALA member facility. 3. Pledge that, upon successful completion of the course, they will practice nursing skills in the long-term care setting for at least one year. Please complete the following application form and give the enclosed recommendation forms to THREE references: the administrator of the NNFA/NALA member facility where you are presently employed; the director of nursing at the same facility; and a third reference such as a teacher, counselor, pastor, rabbi, supervisor, etc. Completed references must be placed in separate sealed envelopes and submitted to NNFA/NALA along with the completed application form and proof of enrollment/acceptance into a nursing school/program by Feb. 28, Incomplete applications will not be considered. Scholarship winners will be announced at the NNFA/NALA Spring Convention Awards Ceremony on April 29, 2014, at the Younes Conference Center in Kearney. Scholarship funds will be forwarded to the appropriate school after verification by the school of the winner s attendance/enrollment. Please indicate which type of school of nursing you plan to attend (CHOOSE ONE): R.N. LPN Name Permanent Address/City/Zip Phone Facility Where Employed Length of employment in a long-term care facility Have you been accepted into a R.N. or LPN School of Nursing? Yes No If yes, please list the name/address/phone/contact person of the school/program and when you will be attending: If not, when and where do you intend to receive your instruction? (Form continued on reverse)

2 Have you had any other special training or instruction related to long-term care? If so, please explain: Have you ever worked as a volunteer in long-term care? If so, please explain: Please describe your interest in long-term care including how you became interested in the profession and related experiences. Please describe your future professional plans in the health care fi eld and your commitment to the long-term care area. If you are awarded a scholarship, do you pledge to practice your nursing skills in a long-term care facility setting for a least one (1) year after completing your course of instruction? Yes No RETURN THIS APPLICATION, THE S IN SEPARATE SEALED ENVELOPES, AND PROOF OF ENROLLMENT/ACCEPTANCE INTO A NURSING SCHOOL/PROGRAM BY FEB. 28, 2014, TO: Nebraska Health Care Foundation 1200 Libra Drive Suite 100 Lincoln, NE (Date)

3 Convention Awards Ceremony, April 29, 2014 in Kearney.

4 Convention Awards Ceremony, April 29, 2014 in Kearney.

5 Convention Awards Ceremony, April 29, 2014, in Kearney.