PeriAnesthesia Nurses Association of California (PANAC) Finances RN Student Scholarship Application Process Last reviewed: February 2015

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1 Finances RN Student Scholarship Application Process Purpose To offer financial assistance to RN nursing students who are or have been employed in a PeriAnesthesia practice setting; including but not limited to the Preoperative or Post Anesthesia Care Unit, PHASE I, Phase II, or Endoscopy Unit in any ambulatory or hospital setting. Requirements for application 1. Enrollment in an accredited ADN or BSN accredited California Registered Nurse Program. 2. Enrollment in the 3rd or 4th Semester of an ADN school or the 3rd or 4th year of a BSN program. 3. One year past or current employment in a PeriAnesthesia care department. Scholarship $ awarded annually to one (1) eligible applicant based on the following criteria 1. Current PeriAnesthesia employee status or up to one year prior to filing of application. 2. Completeness of application. 3. Application letter describing the following: a. Applicant's PeriAnesthesia experience b. How the PeriAnesthesia work experience or a PeriAnesthesia nurse influenced the decision to pursue a nursing career. c. Interest in returning to PeriAnesthesia nursing practice and/or future nursing goals. d. Future education goals. e. Special interests or volunteer activities.

2 Page 2 RN Student Scholarship Application Process (02/15) 4. Letter of recommendation from current or past PeriAnesthesia manager or supervisor. 5. Letter of recommendation from Nursing Instructor. 6. Application form signed by the Director of the School of Nursing 7. Attendance in an accredited School of Nursing: ADN or BSN. 8. Currently a Junior or Senior (BSN) RN student or third or fourth RN semester (ADN) student. 9. Grade point average of 3.0 (B) or above. Application acceptance August 1 October 1, postmarked on or before October 1. Recipient notified and scholarship awarded by November 1. Applications may be mailed or (scanned attachments) to PANAC President P.O. Box Westminster, CA (Scanned attachments) to: Applications will be judged on completeness and content by appointed PANAC Board members who will review applications and the PANAC scholarship process.

3 Forms and Attachments RN Student Scholarship Application Checklist Application Complete and Signed Letter of Application: Maximum of 3 pages, double spaced, font. Describe your PeriAnesthesia experience and other work experience. Describe your PeriAnesthesia experience or how a PeriAnesthesia Nurse influenced your decision to go into nursing. Describe areas of interest in future nursing practice and/or interest in returning to perianesthesia nursing practice. Future educational goals Special interests or volunteer activities. Signature of Director of School of Nursing Letter of Recommendation from work place manager or supervisor, current or past Letter of Recommendation from Nursing Instructor Unofficial Transcript I affirm that I meet the eligibility criteria and all information on this application and any submitted documentation is correct to the best of my knowledge. Falsification or failure to follow all instructions will disqualify my application. I hereby give permission for PANAC to use and duplicate submitted materials for the purposes of review, association publications, promotion and placement in PANAC files. Signature: Date:

4 Forms and Attachments PANAC Student Nurses Scholarship Application Form Purpose: To offer financial assistance to RN nursing students who are or have been employed in a perianesthesia practice setting; including but not limited to the Preoperative or Post Anesthesia Care Unit, Phase II, or Endoscopy Unit, in any ambulatory or hospital setting. Requirements for application: Enrollment in an accredited ADN or BSN accredited California Registered Nurse Program. Enrollment in the 3rd or 4th Semester of an ADN school or the 3rd or 4th year of a BSN program. Prior or current employment in a perianesthesia department. Scholarship: $ awarded annually to one eligible applicant based on the following criteria: Qualified current or past perianethesia employee status. Completeness of application. Letter describing the following: o Applicant's perianesthesia experience o How the perianesthesia work experience or a perianesthesia nurse influenced the decision pursue a nursing career. o Interest in returning to perianesthesia nursing practice and/or future nursing goals. o Future education goals. o Special interests or volunteer activities. Letter of recommendation from current or past perianesthesia manager or supervisor. Letter of Recommendation from Nursing Instructor. Application form signed by the Director of the School of Nursing Attendance in an accredited School of Nursing: ADN or BSN. Currently a Junior or Senior (BSN) RN student or third or fourth RN semester (ADN) student. Grade point average of 3.0 (B) or above. Applications accepted: August 1 October 1 (postmarked on or before October 1). Scholarship is awarded and recipient notified by November 1. Applications may be mailed to: (Scanned Attachments to: PANAC President P.O. Box Westminster, CA Applications will be judged on completeness and content by appointed PANAC Board members who will review applications and the PANAC scholarship process.

5 RN Student Scholarship Application PeriAnesthesia Nurses Association of California Third or Fourth semester (ADN) or Junior or Senior (BSN) RN students are invited to apply for the PANAC Student Nurse Scholarship. Please fill out the form and return to PANAC along with required documentation. Name Address City State County Phone Number cell or home (circle one) print carefully Academic Affiliation: University /College name School Address School Accreditations: Head of Nursing Department Nursing Department phone I am in my semester of a year program. Expected Graduation date Signature of Director, School of Nursing: Work History: I worked in the department at Hospital/surgery center name Address Phone number Department Manager Phone number Position Employment dates Signature: Date:

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