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.

Please note, scholarship application forms may be completed by the individual (RN) seeking to receive a scholarship or their supervisor. 

To qualify for a scholarship, RNs must have submitted a completed nomination form (this form); have an active Oregon RN license; and be currently employed by a licensed Oregon long term care facility, licensed in-home care agency, or level 3 medical complex adult foster home. Scholarships are available on a first come, first served basis. 

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
  • Meet program requirements but must go on the scholarship waitlist due to availability issues 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.

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* 1. Applicant Information (RN's Information)

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* 2. Nominator Information (If Different from Applicant)

Scholarship recipients must be currently employed by a licensed Oregon long term care facility, licensed in-home care agency, or level 3 medical complex adult foster home. 

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* 3. Please review the attestation below.

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

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* 5. The Gero Nurse Prep scholarship includes the opportunity to participate in a cohort, to further learning and network with other nurses. Cohorts are optional and participants may change cohorts once they start the program. What month would you/the person you are nominating be most interested in starting a cohort? (Please rank cohort preference.)

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* 6. Why are you interested in this program?

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