Scholarship Application

 

MICHIGAN ENA SCHOLARSHIP

(FOR CONTINUING EDUCATION) APPLICATION FOR FUNDS

(You may attach another page if needed )

1. BIOGRAPHICAL DATA

A. Name_____________________________

B. Address __________________________

HOME Phone _________________, W Phone _________________

CELL_________________, FAX ____________________

D. E-MAIL_________________________

E. ENA MEMBERSHIP NUMBER______________

F. MENA Chapter_____________________________________________

G. Reference Name (chapter president or MENA board member)_____________________________________________________

2. NAME OF CLASS/CONFERENCE:______________________

A. GIVE A BRIEF DESCRIPTION OF THE CLASS/CONFERENCE

B. DATES OF CLASS/CONFERENCE

C. HOW WILL THIS ENHANCE YOUR PROFESSIONAL CAREER IN EMERGENCY NURSING?

3. EXPENSES/RESOURCE/ MONIES REQUESTED

A. WILL YOUR EMPLOYER COVER EXPENSES? IF SO HOW MUCH?

$_________________________

B. OTHER GRANTS FUNDING: $________________________

C. AMMOUNT OF MONEY REQUESTED

$___________________

4. HOW WILL YOU SHARE WHAT YOU LEARNED FROM THIS CLASS/CONFERENCE WITH MICHIGAN ENA MEMBERS?

Submit in writing with proof of enrollment to the MENA President in c/o Chris Baker, 5400 Groveland, Holly, MI 48442 or e-mail document to baker1016@comcast.net  . Allow at least 60 days for processing your request

MENA Scholarship Application Form

MENA-Scholarship-Form.pdf