Central Florida Association of Rehabilitation Nurses

 

Scholarship Application

 

  1. Print out all the pages of this application. Click here for PDF Version.
  2. Read this application carefully before completing.
  3. Attach all requested additional information.
  4. Sign the completed application and mail to CFARN by November 30, 2016.

 

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 Florida Nursing License Number: ____________________________

 

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

 

  1. Will you be receiving financial help toward your education from an employer or relative?____________________________________________
  2. Will you have an income from work, which will continue, while you are in school? ______________________________________________

This year?______Amount per month._________________________

  1. Will you be receiving any other financial award for school?____________

If yes, please explain.____________________________________

  1. Do you have personal savings you can use for your education?_________

Amount._____________________________________________

  1. Will you be able to attend this college or university if you do not receive a scholarship from this organization?____________________________
  2. Please add any other comments that you wish to regarding your financial situation.________________________________________________________________________________________________

 

 

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 Florida for a minimum of one year. I certify that all statements are truthful to the best of my knowledge.

 

Signature of Applicant                          Date

 

ATTACH A COPY OF YOUR LATEST OFFICIAL TRANSCRIPT

 

 

Central Florida Association of Rehabilitation Nurses

 

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

 

  1. Commitment to working in the field of rehabilitation in Florida.
  2. Cumulative grade point average of 3.0
  3. Financial need.

 

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, 2016

 

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

708 Muirfield Circle

Apopka, FL 32712

407-383-3756