Application Form: Gero Nurse Prep

This is an application form to apply for a full scholarship for the Gero Nurse Prep online training course, via the Oregon Health Care Association with funding from the Oregon Department of Human Services (ODHS). More details are here: https://www.ohca.com/events/gero-nurse-prep-course/.

Please complete all required questions and hit the "Submit the Application Form" button for your form to be completed and processed. Incomplete forms will not be considered.

To qualify for a scholarship, RNs must have submitted a completed nomination form (this form) and have an active Oregon RN license. There is currently no requirement to work in certain settings. Scholarships are available on a first come, first served basis until scholarships run out or by June 30, 2024, at the latest.

Please contact OHCA, info@ohca.com, with any questions or concerns.

Follow-up Communication
OHCA will communicate directly with scholarship applicants within 15 business days following submission of this form.

Applicants will be notified if they :

Meet program requirements and are approved for a scholarship OR
Do not meet program requirements

Individuals that are notified that they are approved for a scholarship will receive follow-up communication from the Gero Nurse Prep Course staff, located within the College of Nursing at the University of Nebraska Medical Center. This will include instructions for course enrollment, how to access the course, and what to do to join a cohort.

Question Title

* 1. Applicant Information (RN's Information)

Name *

Primary Organization (Facility/Organization/Hospital Name) *

Organization Type (ALF, RCF, SNF/NF, IHC, AFH, hospital, other, etc.) *

Job Title

Email *

Phone Number

Question Title

* 2. Nominator Information (If Different from Applicant)

Name

Primary Organization

Job Title

Phone Number

Question Title

* 3. Do you/does the intended scholarship recipient (listed in Q1) have an active registered nurse (RN) license in Oregon?

Yes

Question Title

* 4. The Gero Nurse Prep scholarship includes the opportunity to participate in a 20-week cohort, to further learning and network with other nurses. Cohorts are optional and participants may change cohorts once they start the program. Which cohort session would you like to join? (please rank)

Application Form: Gero Nurse Prep

Question Title

* 1. Applicant Information (RN's Information)

Question Title

* 2. Nominator Information (If Different from Applicant)

Question Title

* 3. Do you/does the intended scholarship recipient (listed in Q1) have an active registered nurse (RN) license in Oregon?

Question Title

* 4. The Gero Nurse Prep scholarship includes the opportunity to participate in a 20-week cohort, to further learning and network with other nurses. Cohorts are optional and participants may change cohorts once they start the program. Which cohort session would you like to join? (please rank)

Question Title

* 5. Why are you interested in this program?