2015 Karen O'Neil Application


WELCOME to the MENA site

 

KAREN O'NEIL

SCHOLARSHIP FUND APPLICATION

Name: __________________________ Credentials: ______ ENA#/Exp. Date ________

Address:_________________________________________Chapter:________________

Phone#: (H)__________(C)___________(W)__________Employer ________________

 

Reason applying for Scholarship: Check appropriate box: TNCC____ENPC____CEN____ENCARE____

National ENA Scientific Assembly _____ National Leadership Conference __________

NERS _______ Other ENA-Sponsored Activity: Please Specify ______________________

 

 

ALL APPLICATIONS MUST BE RECEIVED IN ADVANCE OF THE ENA SPONSORED PROGRAM. SCHOLARSHIP RECIPIENTS WILL RECEIVE THEIR AWARD UPON SUCCESSFUL COMPLETION OF THE COURSE.

SEND APPLICATION THEN VERIFICATION TO:

 PRESIDENT MASSACHUSETTS ENA:

 Julie Bunn

21 Puritan Rd.

Salem, Ma 01970

 

A brief explanation as to why you would like to attend this conference/workshop:

A specific number of points have been assigned to the following activities for the purpose of determining eligibility for scholarship awards. You must have points from at least 2 categories. If you use chapter meetings as part of the criteria you must have chapter president sign your application. Indicate how you meet the qualification on the line next to the activity. Qualification follows the calendar year.

 

CATEGORY 1: PARTICIPATION

Points/Total

ENA Officer: State or Chapter____________________________________ 20 ____

Committee Chair: State or Chapter_________________________________ 15 ____

Committee Member: State or Chapter_______________________________ 5 ____

(Plus 5 points each committee meeting)______________________               5 ____

National ENA Involvement:_______________________________________ 10 ____

Chapter Meetings Attendance (10 points/meeting)#____________________ 10 ____

State Council Chapter Rep/Meetings Attendance (10 points/meeting)#_____ 10 ____

New Member as of current calendar year____________________________ 10 ____

CATEGORY 11: PROFESSIONAL DEVELOPMENT

Points/Total

Current CEN, TNCC, ENPC, FAEN Please specify and list # ____________ 5 ____

Current TNCC-I, ENPC-I, ENCARE-I Please specify __________________ 10 ____

Attendance at ENA sponsored seminars (2 points/day)__________________ 2 ____

(Please specify)_________________________________________________

 

CATEGORY 111: TEACHING/EDUCATION

Presenting: Lectures related to ENA/Emergency Nursing _______________ 10 ____

Serving as a preceptor/mentor in emergency nursing____________________ 5 ____

Published Articles on emergency nursing_____________________________ 10 ____

Projects: Public Education, Legislative Involvement, Other_______________ 10 ____

Nursing Award or Special Recognition_______________________________ 5 ____

(Please specify all categories above)

Points: Category 1: _____

Category 11: _____

Category 111: _____

TOTAL POINTS: _______ PROGRAM COST: _______

 

*AWARD WILL BE AWARDED ACCORDING TO TOTAL POINTS

*EACH MENA MEMBER WILL BE ELIGIBLE FOR

ONE SCHOLARSHIP PER CALENDER YEAR

*TOTAL AWARD WILL NOT EXCEED THE COST OF THE PROGRAM

>150 points =$150

> 75 points = $100

> 50 points = $ 75

> 25 points = $ 50

Signature of applicant:___________________________________ Date:_____________

Chapter president (if applicable):___________________________ Date:_____________

***********************************************************************

SCHOLARSHIP COMMITTEE USE ONLY

Approved: Yes____No____ Scholarship Amount: ________ Date: ___________

Signature: __________________________

 

Thank you for your application and dedication to Emergency Nursing.

MENA 11/5/15