Scholarship
Application
PLEASE
PRINT OR TYPE
Part 1: General Information
Name:___________________________________________________
First
Middle Last
Mailing Address:___________________________________________
Street City State Zip
Phone Number: Home_________________
Work __________________
Social Security Number: _______________________________________
State of
ARN Membership Number:
____________________ Expiration
Date:______
I belong to the ____________________________District
If you are not a Tri-Level member, please answer the
following questions:
I am the dependent of a Tri-Level Member: Yes ______ No _______
I am being sponsored by a Tri-Level Member: Yes ______ No
_______
Part 2: Education
College Last Attended:
_____________________________________
Name
Address
City State
Entrance Date
Specify graduation date or date last attended
Current
Educational Plan
College or University you currently are attending:
Name
Address
Classification: Freshman_______ Sophomore_____ Junior _______ Senior______ Graduate Student ___________
Date that you expect to graduate______________________________
Cumulative Grade Point Average______________________________
Will you be attending College full time in the year for
which you are applying for a scholarship?___________________________________
Part 3: Confidential Statement of Financial Condition
This year?______Amount per month._________________________
If yes, please explain.____________________________________
Amount._____________________________________________
Part 4: Summary of Professional and Educational Goals and
Achievements
Please attach a typed summary of your professional and
educational goals and achievements. Please include the following areas in your
summary:
a: Your resume
b: Efforts you have made to improve
your rehabilitation nursing practice and delivery of care in your work
setting(s).
c. Presentations or professional publications.
d. Community involvement, particularly related to
advocating for individuals with disabilities.
e. List any academic, civic, professional or athletic
awards.
f. Involvement in ARN at the district, state and/or
national level/
g. Goals that you hope to implement with the completion of
this degree.
Part 5: Rehabilitation Nursing Value Statement
Attach a description of what rehabilitation nursing means
to you and why you want to advance your career in rehabilitation nursing.
Include in this your strengths and weaknesses in the field of rehabilitation
nursing and your vision for this specialty in the future. (250 words)
Part 6: Conduct
I have ____ have not ____ been convicted of any misdemeanor or crime. (If
affirmative, please explain.)
If
awarded the CFARN scholarship, I shall accept it with the knowledge that said
scholarship will be revoked for good cause as determined by the committee. I
further agree to commit to work in the field of rehabilitation in the state of
Signature
of Applicant Date
ATTACH A COPY OF YOUR LATEST OFFICIAL
TRANSCRIPT
CFARN Scholarship Guidelines
A
$500.00 Scholarship will be awarded to a member or a nursing student at
a local college who meet the following criteria:
Applicant
Criteria
How
to apply
Complete
the attached application form and submit it along with an official copy of your
current GPA, the requested financial statement, one personal reference, two
professional references and supportive statements to the address listed below.
Postmark Deadline: November 30, 2021
The
selection of candidates will be done by the CFARN Scholarship Committee. The
Scholarship will be presented at an upcoming meeting.
Send
application Form and Materials to:
Italia-Lee Bright, RN, BSN, CRRN, CCM
407-383-3756