New York State Chapter IAFN Member Scholarship Application

NYS Chapter IAFN Member Scholarship Application

Complete all sections and submit for consideration. All portions of the application must be completed for consideration.

Question Title

* 1. Applicant Contact Information:

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

Question Title

* 2. Place of Employment/ Educational Institution:

Question Title

* 3. Does your employer/ organization provide funds for training/education?

Yes

Other (please specify)

Question Title

* 4. If you answered Yes to question 3, have you requested those funds?

Yes

Question Title

* 5. Summary of your current work in forensic nursing field:

Question Title

* 6. How will this funding personally enhance your forensic nursing practice?

Question Title

* 7. Describe your community and the impact this educational funding will have on that community:

Question Title

* 8. Describe your plan for sharing and disseminating knowledge gained with others?

Question Title

* 9. Describe the reason you are requesting financial assistance?

Question Title

* 10. What differentiates you from other candidates? Why should you be awarded a scholarship this year?

Question Title

* 11. # of years you have been an IAFN Member?

Question Title

* 12. # of years you have been a New York State Chapter IAFN Member?

Question Title

* 13. Is your IAFN Membership Current?

Question Title

* 14. Is your New York State Chapter IAFN Membership Current?

Question Title

* 15. Have you received a NYS Chapter- IAFN Funding previously?

Question Title

* 16. If you answered Yes to #15, when, how much, and for what did you receive funding for?

Question Title

* 17. Education Event Requesting Scholarship Funds to attend: Event Title:

Question Title

* 18. Event Date:

Question Title

* 19. Event Location:

Question Title

* 20. Event website (if a website is not available, a copy of the event flyer must be emailed to iafnnys@gmail.com)

Question Title

* 21. Expected Expenses and Total Cost:

Expenses Description:

Cost:

Total Amount of Funding Requested ($500 Maximum)

Question Title

* 22. If committee is unable to fund your full amount requested, will you attend the event if only partially funded?

Please keep in mind that funds are limited and may or not be available at the time of your request.

PLEASE NOTE: IF YOU ARE APPROVED FOR FUNDING, FUNDS WILL BE PROVIDED AS REIMBURSEMENT AFTER ATTENDANCE COMPLETION CERTIFICATE AND EXPENSE RECEIPTS ARE SUBMITTED TO THE NYS CHAPTER IAFN EMAIL at IAFNNYS@GMAIL.COM

?? QUESTIONS?? Please contact IAFNNYS@gmail.com