JOE ANN CLARK GRADUATE NURSING EDUCATION AWARD Fall, APPLICATION DEADLINE: TUESDAY, November 10, 2015

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1 PURPOSE: JOE ANN CLARK GRADUATE NURSING EDUCATION AWARD Fall, 2015 APPLICATION DEADLINE: TUESDAY, November 10, 2015 The Louisiana State Nurses Association offers this award to honor Dr. Joe Ann Clark for her distinguished career in professional nursing in Louisiana. Dr. Clark exemplifies the highest values of the nursing profession and is recognized for her significant contributions in nursing leadership and education. AWARD: The goal of this award is to provide financial support to a registered nurse pursing graduate education for preparation as a nurse educator in an academic environment. The award is made on a competitive basis to professional nurses enrolled in an accredited graduate nursing program. The award will be offered on an annual basis when possible. Recipients may receive this financial award one time only. The award this year has been increased to $1,500, to help defray Spring, 2016 academic expenses. Full time or part-time students in Masters, post-masters, or Doctoral programs, whether on-site or on-line, may apply. Announcements will be made on the LSNA website ( in the Pelican News and other publications and programs provided by the Louisiana State Nurses Association. The most deserving recipient will be selected based on the established criteria and potential commitment to ongoing contributions to teaching & leadership in the nursing community. All applicants will be notified of the committee s decision in a timely manner. Financial arrangements for this award will be managed through the Louisiana Nurses Foundation (LNF). REQUIREMENTS: All information requested in the application process must be typed using the application forms available on the LSNA website at The application must be completed in entirety, with hard copy mailed and postmarked by the published DEADLINE of midnight on NOVEMBER 10, The recipient will agree to provide academic progress updates and upon program completion, provide data on employment and related professional activities for a period of two years following the award. APPLICANT QUALIFICATIONS: 1. Hold a current, unencumbered license to practice as a Registered Nurse in Louisiana. 2. Students pursuing a nursing education track and having a nursing education focus to qualify them as academic nursing faculty in Louisiana are encouraged to apply.

2 3. Be admitted without conditions/fully matriculated in a graduate nursing program that is nationally accredited by the NLNAC or CCNE, whether on-line or on-site. Preference will be given to applicants with enrollment in a Louisiana graduate nursing program. 4. Although not required, preference will be given to those with current ANA &/or LSNA membership. 5. Demonstrated competence in graduate study as evidenced by successful completion of at least 6 total graduate hours of course work. 6. Evidence of a cumulative grade point average (GPA) of 3.0 or greater (on a 4.0 point scale) on all graduate coursework as reflected on an official academic transcript. 7. Using the posted Application Reference Form, provide two (2) signed & completed confidential professional reference forms: one (1) from an immediate supervisor in the employment setting and one (1) from a graduate nursing faculty member, who can attest to potential for success in completing graduate study, and potential for teaching, and commitment to nursing. 8. Validation of Louisiana residency by attachment of copy of driver s license or voter registration. (If residency is unclear, additional information/documentation may be requested.) 9. Submit a Biographical Narrative form (using posted format) reflecting professional nursing education, experience, leadership and professional nursing activities. 10. Provide a statement of student Funding History/Financial Resources (using posted format) for graduate study. 11. Complete a Personal Statement (using posted format) of professional motivation and goals for pursuing a graduate degree in nursing education. 12. Provide dates on which the academic program began, along with the projected date for degree completion. DEADLINE DATE: Hard copies of the completed application and ALL supporting documentation must be mailed and postmarked to LSNA by the stated DEADLINE OF NOVEMBER 10, No faxed materials will be accepted, nor will late applications be reviewed. Note the Scholarship Application Checklist and Required Attachments provided with application materials. If you have questions, contact LSNA at , or by at: lsna@lsna.org MAIL ALL COMPLETED MATERIALS TOGETHER TO: LNF Scholarship & Awards Committee: Fall 2015 Joe Ann Clark Award Louisiana State Nurses Association 5713 Superior Drive, Suite A-6 Baton Rouge, LA

3 JOE ANN CLARK 2015 GRADUATE NURSING EDUCATION AWARD Personal Information: APPLICATION Applicant s Name: _ Current Address:_ Length of Residence: Phone: (H#)(Cell#) address: Graduate Nursing Program:_ Program Address: Applicant Name Signature Date SCHOLARSHIP APPLICATION CHECKLIST Checklist must be completed and accompany application Forms must be placed in the order listed on checklist that follows Personal Information and Scholarship Application Checklist - This page. Verification of Eligibility Form Verification of Graduate Program Admission Form _ Applicant s Biographical Narrative Form including Funding History/Financial Resources _ Applicant s Personal Statement (250 words or less) See p. 4 of Biographical Narrative. ATTACHMENTS: Documentation of Louisiana Residency Copy of driver s license OR voter registration Copy of Program of Study Applicant s attachment. Official academic transcripts Applicant s final undergraduate and current graduate. Two References using Joe Ann Clark Application Reference Form- One Employer and one Academic. 3

4 JOE ANN CLARK 2015 GRADUATE NURSING EDUCATION AWARD VERIFICATION OF ELIGIBILITY 1. Do you currently hold an unencumbered license to practice as a registered nurse in Louisiana? _Yes No 2. Are you a current resident of Louisiana as evidenced by a copy of your driver s license or voter registration? Yes No 3. Are you currently unconditionally admitted and enrolled in an NLNAC or CCNE accredited graduate nursing program, on-line or on-site, pursuing a nursing education track/focus? Yes No Location of program: 4. Have you successfully completed at least 6 graduate nursing hours of coursework? (You may be enrolled full-time or part-time.) Have you earned a cumulative GPA of 3.0 or more (on a 4.0 scale) in graduate coursework as reflected on an official academic transcript? 7. Do you hold current membership in ANA &/OR Louisiana State Nurses Association? (ANA &/OR LSNA Membership is preferred but not required) Yes No ANA? Membership date: LSNA? Membership date: NOTE: APPLICANTS ARE EXPECTED TO COMPLETE AND ATTACH SUPPORTING DOCUMENTS AS STATED ON P. 6. 4

5 JOE ANN CLARK 2015 GRADUATE NURSING EDUCATION AWARD VERIFICATION OF GRADUATE PROGRAM ADMISSION 1) Applicant s Name (Print or Type):_ 2) Current Status in Graduate Nursing Program: Full-time_ Part-time (A full-time graduate student is typically enrolled in a minimum of 9 credit hours.) 3) Graduate Cumulative GPA: 4) This student is currently enrolled in a graduate nursing program designed to prepare nurse educators (education track/focus) and has successfully completed term(s) & credit hours of graduate study in a program designed to be completed in _ full-time terms & credit hours. Comments: 5) This student has been admitted without conditions/fully matriculated in a graduate nursing program that is nationally accredited by the NLNAC or CCNE. 6) Anticipated Degree: Anticipated Date of Graduation: _ 7) Is the student from an under-represented group in nursing, i.e. Male, African American, Asian, American Indian, Alaskan native or of Hispanic background? (LNF may offer other scholarships, as available, to students from under-represented groups.) NO YES Group Represented: Signature of Nursing Program Administrative Official Date Administrative Official s Name and Title (please print) Print Name and Complete Mailing Address of College/University School of Nursing 5

6 JOE ANN CLARK 2013 GRADUATE NURSING EDUCATION AWARD REQUIRED ATTACHMENTS APPLICANTS: (See all forms/materials posted on LSNA website at PLEASE ATTACH EACH OF THE FOLLOWING COMPLETED DOCUMENTS IN THE FOLLOWING ORDER APPLICATIONS MISSING ANY OF THESE COMPONENTS WILL NOT BE REVIEWED: 1.) Application Form with Personal Information and Checklist 2.) Verification of Eligibility Form 3.) Verification of Graduate Program Admission Form 4.) Applicant s Biographical Narrative Form including Funding History/Financial Resources 5.) Applicant s Personal Statement (250 words or less) See p. 4 of Biographical Narrative 6.) Documentation of Louisiana state residency Copy of driver s license OR copy of voter registration. (Note: If residency unclear, more information/documentation may be requested.) 7.) Copy of Program of Study (degree plan) for your graduate nursing program curriculum, reflecting a nursing education focus/track. 8.) Official academic transcripts for undergraduate degree (final) and current/most recent graduate program. 9.) Two (2) completed, signed confidential Joe Ann Clark Application Reference Forms (use form provided on LSNA website): One (1) from an immediate professional nursing supervisor in the employment setting and One (1) from a graduate nursing faculty member, who can attest to potential for success in completing graduate study, potential for teaching, and commitment to nursing. 6