AgriSafe Nurse Scholar Program Scholarship Application (deadline May 30, 2025)

Full Scholarship Opportunity

Thank you for your interest in the AgriSafe Nurse Scholar program! Scholarships will be awarded on a first-come, first-served basis, and the application deadline is May 30, 2025.

To be eligible to receive a scholarship, nurses must meet all of the following requirements:

Be employed in the United States by a rural health clinic, critical access hospital, FQHC, government agency, nonprofit hospital or organization, or work in academia (school or educational institution).
Demonstrate an interest and ability to integrate learnings into their practices.

Applicants granted a scholarship will receive a discount code to use during registration, so please only register for the course once you have received notification of your award. If selected as a scholarship recipient, you will have until, November 5, 2025, to complete all course content.

Thank you to our generous sponsors CHS and CoBank for supporting the AgriSafe Nurse Scholar program.

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* 1. Contact Information:

First Name:

Last Name:

Email Address:

Mobile Phone:

Work Phone:

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* 2. Mailing Address:

Street Address:

City:

State:

Zip Code:

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* 3. Work Information:

Employeer:

Job Title:

State of Nursing Licensure:

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* 4. Which best describes your employer? select all that apply.

Academia

Critical access hospital

FQHC

Government agency

Nonprofit organization

Nonprofit hospital

Private practice

Rural health clinic

School

Other (please specify)

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* 5. Please list the state(s) and counties where patients are impacted by your work (this can be defined as your service area). You may list more than one state/counties

State(s)

Counties

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* 6. Type of Nursing Practice:

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* 7. Level of Education:

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* 8. Please briefly describe your experience in rural healthcare:

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* 9. What is your reason for wanting to participate in the Nurse Scholar program?

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* 10. Describe your plan for implementing change in your work environment, patient care, or community as a result of your participation in the Nurse Scholar program.

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* 11. Please upload your resume.

Failure to upload your resume will make you ineligible for a scholarship.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 12. If you are awarded a scholarship, would you like to be featured as a recipient in AgriSafe’s social media and email announcements? (Your response will not impact scholarship selection.)

Yes, I permit AgriSafe to include my name, job title/organization, state and photo.

Yes, I permit AgriSafe to include my name, job title/organization, and state.

No, I would not like to be recognized.

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* 13. Please upload the photo you'd like us to feature in the scholarship awardee recognition announcement.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File