SCHOLARSHIP APPLICATION

Applications are now being accepted for the CNSA Foundation scholarship for the 2011-2012 academic year. inners will be notified in September. Scholarship recipients will be recogni!ed at the Awards Ceremony during the 2011 CNSA Annual Con"ention in Sacramento and must be present to recei"e scholarship. Eligibility and Selection Criteria Current enrollment in an accredited school of nursing in California# Current NSNA membership $must be "alid through %ctober 1&' 2011(# )ssay submission $worth *0+ of the total score(# %"erall college ,-A of ..0 or greater# )"idence of in"ol"ement in CNSA' NSNA' and/or chapter acti"ities# 0wo current supporting letters of reference. 1ust be present the last day of the 2011 CNSA Annual Con"ention. Please include the following in your application: 1( An essay on the following2 3n 2010' we celebrated 0he 3nternational 4ear of the Nurse. 3t was a year of opportunity as -resident %bama signed the -atient -rotection and Affordability Act $5ealth Care 6eform( and the 3nstitute of 1edicine $3%1( and 6obert ood 7ohnson Foundation $6 7( released2 0he Future of Nursing2 8eading Change' Ad"ancing 5ealth. 0his landmar9 report recommends eight strategies to ad"ance nursing:s influence and participation in the care of our patients and communities. ;eeping in mind 5ealth Care 6eform and the Future of Nursing initiati"e' how do you en"ision your role as a registered nurse e"ol"ing in the ne<t fi"e years= 2( 0he essay must be typed in 12-point font' double-spaced' 1-inch margins' and no more than *00 words. )ssays will be scored on originality' pertinence to topic' content' grammar' and neatness. >>Do NOT type name on essay. .( A copy of college transcript$s(. ?nofficial transcripts are acceptable.

@( Completed rubric of CNSA in"ol"ement/participation. $See below(. *( 0wo current letters of reference addressing your personal characteristics and leadership Aualities that Aualify you for this award. 0he letters need to be addressed to BCNSAC. %ne letter 1?S0 be from a nursing instructor. For pre-nursing CNSA members' one letter may be from a chapter ad"isor.

CNSA SCHOLARSHIP APPLICATION

Please print or type all information Name2 DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD %"erall College ,-A2 DDDDDDDDDDDDDDDDDDDDDDDDDDD

Street Address2 DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD City/State/Eip2DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD -hone2 DDDDDDDDDDDDDDDDDDDDDDDDDD

0ype of Nursing -rogram $AFN' GSN' 6N-GSN' 1asters(2 DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD

-lease chec9 off each application item as it is completed. 3ncomplete applications will not be e"aluated. 1( DDDDDDD An )ssay on the following2 3n 2010' we celebrated 0he 3nternational 4ear of the Nurse. 3t was a year of opportunity as -resident %bama signed the -atient -rotection and Affordability Act $5ealth Care 6eform( and the 3nstitute of 1edicine $3%1( and 6obert ood 7ohnson Foundation $6 7( released2 0he Future of Nursing2 8eading Change' Ad"ancing 5ealth. 0his landmar9 report recommends eight strategies to ad"ance nursing:s influence and participation in the care of our patients and communities. ;eeping in mind 5ealth Care 6eform and the Future of Nursing initiati"e' how do you en"ision your role as a registered nurse e"ol"ing in the ne<t fi"e years= 2( DDDDDDD A copy of college transcript$s(. ?nofficial transcripts are acceptable. .( DDDDDDD Completed rubric of CNSA in"ol"ement/participation @( DDDDDDD 0wo current letters of reference addressed to BCNSAC. %ne letter 1?S0 be from a nursing instructor. For pre-nursing CNSA members' one letter may be from a chapter ad"isor. Applicants Certification2 3 belie"e myself eligible and hereby ma9e application to recei"e this CNSA scholarship. 3 certify that all statements made in this application are complete and accurate. Signature: _____________________________________________ Date: _____________________

Completed application and documentation must be mailed to the following address and RECEI ED !" September 1@' 2011

CNSA / CNSAF 2*20 Henture %a9s ay' Suite 210 Sacramento' CA I*J.. $I1K( &&I-KI@I

CNSA IN OL E#ENT$PARTICIPATION
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STATE LE EL O%%ICE POSITION "EAR CANDIDATE POSITION "EAR CO##ITTEE ROLE "EAR STATE #EETIN& ATTENDEE ANN'AL CON ENTION ()ear* COCR SPRIN&$ S'##ER (season + )ear*

NATIONAL LE EL O%%ICER POSITION "EAR CANDIDATE POSITION "EAR CO##ITTEE ROLE "EAR NATIONAL CON%ERENCE ATTENDEE ANN'AL CON ENTION ()ear* #ID"EAR CON ENTION ()ear*