This scholarship was established to advance the practice of nursing in urology and to honor those exhibiting expertise in their field of practice. This scholarship will be awarded to a SUNA member wanting to advance their knowledge of urologic nursing who otherwise might not be able to attend the Advanced uroLogic Conference.

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* 1. Name, include credentials

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* 2. Street Address, City, State, Zip

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* 3. Phone (best way to reach you)

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* 4. Email Address:

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* 5. Active member of SUNA for the past 12-23 months?

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* 6. SUNA Member since?

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* 7. SUNA Activities (National, Regional and Chapter)

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* 8. CBUNA Certified?

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* 9. CBUNA Credential

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* 10. Education (Place, Graduation Year, Degrees, Certifications)

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* 11. Employment for the past 5 years (Name and position)

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* 12. Articles and/or Presentations in the past 5 years:

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* 13. Type of urologic care you provide:

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* 14. Describe your work setting, your role at work and how this conference will benefit 1) you and your personal growth, 2) benefits your practice, and 3) how information will be disseminated to other heal care team members. Please be specific but limit your comments to 350 words.

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