New Mexico Higher Education Department

Transcription

1 The purpose of the New Mexico Nurse Educator Loan-for-Service is to the enhance the ability of college and university-employed nursing educators and future nursing educators to obtain Bachelor of Science, Master of Science and Doctor of Philosophy degrees. General Eligibility Requirements: Be a citizen of the United States or an eligible non-citizen and a resident of New Mexico. Be accepted by a New Mexico public post-secondary institution into a Nursing Education program necessary to enhance or gain employment in a Nursing faculty position at a New Mexico public postsecondary institution. Be enrolled at least (3) credit hours at the time the loan is awarded and disbursed. Be currently practicing or declare intent to practice as a nurse educator at a New Mexico public postsecondary institution. Application Process: Application Employment Certification for current college and university employed nurse educators ONLY. Written essay Letter of acceptance, unofficial academic transcripts, and proof of enrollment Applicant certification Copy of Driver s License Selection Process: The Health Professional Advisory Committee will screen applications and rank individuals based on the applicant s academic eligibility, ability to describe the need for the program, and intent to work as a nurse educator. Contract: Each student is required to sign a contract agreeing to repay the loan if he or she does not continue to reside in the State of New Mexico and practice as a nurse educator. Annual Award Amounts will be based on enrollment: 9 credit hours and above $7,500 ($3,750 Fall/$3,750 Spring) 6-8 credit hours $5,000 ($2,500 Fall/$2,500 Spring) 5 credit hours or less $2,500 ($1,250 Fall/$1,250 Spring) Awards are not typically made for summer sessions unless funding is available. NOTE: The application and all supporting documents must be received by 5:00PM on July 1, Late applications or applications postmarked with the July 1st date but received after July 1 st deadline date will not be accepted. Mail to the following address: New Mexico Higher Education Department Financial Aid Division 2044 Galisteo Street, Suite 4 Santa Fe, NM For further information, please contact a financial aid representative at or visit our website at

2 Section A: Applicant Information Check One: Current Nurse Educator employed at a New Mexico public post-secondary institution Registred Nurse or Advance Practice Nurse declaring intent to practice as a Nurse Educator at a New Mexico public post-secondary institution. Contact Information Permanent Address: Street Address Apartment/Unit # City State ZIP Code Home Phone: ( ) Alternate Phone: ( ) Social Security Number: Date of Birth: Previous name under which records may be kept: Address: Gender: Male Female Driver s License Number: State: Ethnicity: Anglo African American Hispanic Native American Other Are you a New Mexico resident? Yes No If yes, when was residency established? High School Grad Date: High School City, State Have you applied for the NM Nurse Educator Loan-for-Service program in the past? Yes No If yes, what year did you apply? Did you receive funding? Yes No How did you hear about the Loan-for-Service Program? Name of Institution Attending/Plan to attend: Approved degree you plan to obtain: Education Information Anticipated Graduation Date: Current Level: FR SOPH JUNIOR SENIOR GRAD References List two individuals with separate contact information who can be reached for your most current address. Address: Primary Phone: Street Address City State ZIP Code Relationship: Address: Primary Phone: Street Address City State ZIP Code Relationship:

3 Section B: Employment Verification for Current College and University (complete if you are currently an employed nurse educator, if not leave section blank) To Be Completed By Employer. Applicant Name: Employer Name: Employer Address: Employer Phone: Employer Fax: Courses Taught: Dates Employed: From: To: Employment Status: Full-time Part-time Number of hours worked per week: I certify that the information provided above is true and complete to the best of my knowledge. If asked by the New Mexico Higher Education Department, I will provide proof of the information I have reported. I understand that all information can will be used in a legal capacity if necessary. Signature of Employer Date Printed Name: Title: Telephone Number :( ) Address:

4 Section C: Essay Please Type (Minimum of 400 words, 500 Maximum) Please include your first and last name on the attachment. Essay must be typed and attached on a separate page. Explain your need for this loan-for-service program and why you are interested in being a Nurse Educator in New Mexico. Section D: Letters of Recommendation Please enclose two letters of recommendation from an employer, an educator, a mentor, a colleague, or other professional reference. The letters should explain why the applicant would be a good candidate for an educational loan to obtain a degree as a nurse educator. The letter should also explain the individual s level of commitment to teach in New Mexico. Section E: Attachments Letter of Acceptance Official Academic Transcripts (official transcripts may remain in official sealed envelope) Copy of Driver s License Submit your letter of acceptance into the health profession program in which you are enrolled along with your official college transcripts. NMHED must receive proof of enrollment for the semester you are requesting funding before funding will be released. Section F: Applicant Certification I understand that the application packet will not be considered complete unless the following documents are submitted: Application (Section A): Complete and sign the New Mexico Nurse Educator Student Loan-for- Service Program application. Employment Verification (Section B): Employer must complete Employment Verification Form and return the signed form to the applicant to mail with the completed application packet. This section is only required only for applicants that are current Nurse Educators employed at a New Mexico public post-secondary instution. Written Essay (Section C): Submit your typed essay on a separate sheet of paper. Two Letters of Recommendation (Section D): To be completed by an employer, an educator, a mentor, a colleague, or other professional reference. (please attach to packet without envelope) Attachments (Section E): Letter of Acceptance, Official Academic Transcripts and Proof of Enrollment and Driver s License. (official transcripts may remain in official sealed envelope) Applicant Certification (Section F): Sign this form and submit with your application. Application cannot be accepted if not signed.

5 I understand that the original application and any necessary documents must be received in our office by July 1, Late applications or applications postmarked with the July 1st date but received after July 1 st deadline date will not be accepted. I understand that all awards are subject to the availability of funds. STATEMENT OF INTENT TO PROVIDE SERVICE IN NEW MEXICO I affirm intent to practice as a nurse educator during my education or upon completion of my education and/or internship/residency. I understand that if selected to receive funding, I must fulfill the service requirements of this loan or repay the loan with interest as defined in the Nurse Educator Loan-for-Service Agreement and in the New Mexico Administrative Code All the information on this application is true and completed to the best of my knowledge. If asked by the New Mexico Higher Education Department, I will provide proof of the information I have reported on this application. All information can and will be used in a legal capacity if necessary. Signature Date