AgriSafe Nurse Scholar Program - Farm Credit Illinois Scholarship Application 2022

Thank you for your interest in the AgriSafe Nurse Scholar program. Farm Credit covers the full amount for the course. Nurses working in Illinois who work in rural health clinics, government agencies, academia or non-profit organizations are eligible for this scholarship, will need to pay a $250 refundable deposit, which will be fully refunded upon completion of the course. Nurses working in all other areas will need to pay a $500 refundable deposit, which will be fully refunded upon completion of the course. 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 the March 15, 2023 deadline.

These scholarships are made possible by Farm Credit Illinois.

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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. Level of Education:

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* 5. Type of Nursing Practice:

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* 6. County of Residence

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* 7. Phone number

Work Phone

Mobile Phone

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* 8. State of Nursing Licensure

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* 9. Job Title

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* 10. Current Employer

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* 11. Are you an immediate family member of an employee at Farm Credit?

Yes

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

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

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

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* 15. If you receive the scholarship do you agree to share your contact information, photo and statement to the sponsoring association for promotion?

Yes