AgriSafe Nurse Scholar Program 2022 - Scholarship Application

Thank you for your interest in the AgriSafe Nurse Scholar program. Nurses working for nonprofit organizations, rural health clinics, federally qualified health centers, government agencies or educational institutions are eligible to apply for the stipend award, which is valued at $250.

Applications will be reviewed on a rolling basis and applicants will receive a response within 5 business days from when the application was received.

Applicants granted a scholarship will receive a coupon code to use on registration, so please do not register for the course until you have received your coupon code.

In order to receive CNEs for this course, you must complete ALL course content before March 15, 2023.

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* 1. First and Last Name

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* 2. Preferred Email

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* 3. Mailing Address

Address

City

State

Zip Code

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* 4. Phone number

Work Phone

Mobile Phone

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* 5. Type of Nursing Practice

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* 6. Level of Education

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* 7. State of Nursing Licensure

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* 8. Job Title

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* 9. Current Employer

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* 10. Briefly describe your current work in rural healthcare:

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* 11. What is your reason for participating in the Nurse Scholar program?

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