FNRE Scholarship Application

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1 East Holly Avenue, Box 56! Pitman, New Jersey (856) FAX (856) FNRE Scholarship Application Foundation for Neonatal Research and Education (FNRE) (Instructions--please read prior to the completion of any forms) Eligibility 1. You must be officially admitted to a college or school of higher education for one of the following: (a) Bachelor of Science in Nursing (current RN), (b) Master in Science in Nursing for Advance Practice in Neonatal Nursing, (c) Doctoral degree in Nursing, (d) Masters or Post-Master degree in Nursing Administration or Business Management. 2. You must have a GPA of 3.0 or higher. 3. You must be a professionally active neonatal nurse as evidenced by: * Actively engaged in a service, research, or educational role that contributes directly to the health care of neonates or to the neonatal nursing profession. (includes all professional neonatal nursing roles and neonatal nursing students.). * An active member of a professional association dedicated to enhancing neonatal nursing and the care of neonates whose mission is consistent with the mission of the Foundation for Neonatal Research and Education (FNRE) * Demonstration of ongoing professional education in neonatal nursing as demonstrated by at least 10 contact hours in neonatal content in the past 24 months. Or neonatal nurses enrolled in degree nursing programs (advanced or RN to BSN) during the same time period. 4. You must not have received a FNRE scholarship or grant in the past 5 years. 5. If awarded both a FNRE scholarship and grant concurrently, then only one can be kept. 6. Members of the FNRE Board and the FNRE Scholarship Review Committee are ineligible to apply during their term. Procedure for Application Submission 1. Submit a completed FNRE Scholarship application. (Part G is kept by the FNRE central office and is not included in materials submitted to the Scholarship Review Committee. 2. A current résumé or curriculum vitae must accompany the application including evidence of professional memberships and contact hours earned in the past two years. 3. An official transcript from each college or school of higher education must accompany the application.

2 Procedure for Application Submission (Cont d.) 4. A letter of verification of enrollment and acceptance to a college or school. 5. Evaluation forms shall be submitted in the following manner: a. CNS applicants: Submit a separate form from a nurse manager or supervisor and two members of the health team. b. NNP applicants: Submit a separate form from a nurse manager or supervisor, a practicing NNP, and a neonatologist or other pediatric physician practicing in neonatal care. c. Nursing Administration or Business Management applicants: Submit a separate form from a nurse manager or supervisor and two members of the health team. d. Doctoral applicants: Submit a separate form from a supervisor and one member of program faculty, and one member of the health team. e. BSN applicants: Submit a separate form from a nursing supervisor and two members of the health team. It is your responsibility to ensure that these letters are received in the FNRE central office on or before the date the application is due. 6. Submit a statement of 250 words or less addressing how you plan to make a significant difference in neonatal nursing practice. 7. All completed applications must be in the FNRE Central Office no later than May 1 st of each year. Scholarship award notifications will be mailed by September 1 st of each year. INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED.

3 East Holly Avenue, Box 56! Pitman, New Jersey (856) FAX (856) FNRE SCHOLARSHIP APPLICATION Scholarship you are seeking: Neonatal Nurse Practitioner BSN Clinical Nurse Specialist MA Nursing Management Doctoral Personal Information (Please type or print clearly) A. Full legal name: Last Name First Middle List any other names on your records: Social Security No.: Credentials: B. Address: Street City State Zip Code Home phone: ( ) Work phone: ( ) Fax: C. Current professional memberships: Expiration: D. Professional license: Number: State: E. How did you hear about this scholarship? College and University or Other School Information (List all college, universities or schools of nursing attended and provide official transcripts) Degree/Diploma Name of Institution City and State Entrance date earned and date

4 Academic Information: Full time: Part time: Expected Graduation: GPA: F. Reasons for scholarship application: (additional sheet may be used) G. The following optional information is not used in the selection decision. Birth date: Female: Male: Citizenship: USA Other: Type of Visa? Ethnicity: African/American Hispanic American Indian or Alaskan Native Asian or Pacific Islander Caucasian/White Other I hereby certify that to the best of my knowledge the information furnished in this application is true and complete. I understand that if found to be otherwise, it is sufficient cause for rejection. Signature: Date: Print name: FNRE SCHOLARSHIP APPLICATION CHECK LIST Application Resume or curriculum vita Enrollment or verification letter Statement addressing how you will contribute to advanced practice 3 Evaluations Transcripts

5 FNRE LETTER OF EVALUATION (Instructions) Directions to the Evaluator: The person named below is applying for a scholarship from the Foundation for Neonatal Research and Education (FNRE). You have been selected by the applicant to submit your comments on the applicant=s qualifications. The enclosed Evaluation Form is due by May 1 st of each year. If you cannot return it by this date, please notify the applicant as it may disqualify the application. Please complete the Evaluation by appraising the applicant in relation to other individuals functioning in a similar capacity. The information supplied on this form will be used to assess the applicant=s qualifications for the scholarship. Your comments will be held in confidence if the applicant has authorized the statement below. Once completed, please return the form in the enclosed self addressed envelope. FNRE EVALUATION WAIVER Directions to Applicant: Prior to giving this form to the evaluator, complete the following: Applicant=s Name: (Please print) Soc. Sec. #: Current Address: City: State: Zip Code: I waive the right to inspect this confidential evaluation. I understand this form will be used by the Foundation for Neonatal Research and Education and its appointed and elected officers solely for the purpose of selecting the best candidates to receive scholarships as set forth by the criteria established by FNRE. I further understand that, according to the Family Educational Rights and Privacy Act of 1974, this waiver is optional. Signature Date

6 FNRE SCHOLARSHIP EVALUATION Applicant s Name: (Please Type or Print) 1. Clinical Judgment and Skills 2. Leadership Potential 3. Relationships with Health Team Members Comments 4. Communication Skills

7 Applicant s Name: (Please Type or Print) 5. Professional Involvement: Comments 6. Ability to Handle Intensive Course of Study 7. Work Habits 8. How long have you known the applicant? years months 9. Under what circumstances have you known the applicant?

8 Applicant s Name: (Please Type or Print) 10. What are the applicant=s primary strengths? 11. Please Indicate Your Recommendation [ ] Strongly Recommend [ ] Recommend [ ] Recommend with reservations [ ] Do Not Recommend 12. Additional Comments Please print clearly Your name: Title: City: State: Zip: Signature: Date: Postmark this evaluation form by May 1st and mail to: Foundation for Neonatal Research and Education (FNRE) FNRE Coordinator c/o Anthony J. Jannetti, Inc. 200 East Holly Avenue Box 56 Pitman, NJ / C fax 856/

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