The Imogene Ward Nursing Scholarship Award Application

The Imogene Ward Nursing
Scholarship Award Nomination Form

The scholarship is limited to those pursuing an education to become registered nurses – in honor of Mrs. Ward, who was an RN. A nomination may be made by either a direct or indirect supervisor, and it does not need to be their current supervisor. The nominating person (nominator) does not need to be a FADONA member. If not, a FADONA member must endorse the nomination by submitting a letter of recommendation to FADONA. This allows an administrator or other person who supervises a nurse to be able to identify a worthy employee. The nominee must be enrolled in an accredited Florida nursing program. The nominee must be actively employed by the same facility or employer as the nominator. The nominee must be willing to pledge a minimum of two (2) years, working full-time in long-term care, in the state of Florida. The nominee must demonstrate a determination to overcome personal and/or professional obstacles to pursue his or her nursing education to become an RN. The nominee must have a track record of excellence and the potential for future leadership in long-term care. A FADONA/LTC scholarship award winner is not eligible to participate in the Ward Scholarship during the same calendar year. The nominee may be interviewed over the telephone by the Scholarship Committee, or its designee(s).

You must complete all sections with asterisk in order to submit this application.

*Your Name (Nominator):
*Title:
*Address:
*City/State/Zip:
*Phone Number:
*Fax Number:
*E-mail:

*Name of Nominee:
*Nominee's Position:
E-mail:
*Address:
*City/State/Zip:
*Phone Number:


*Employer:
*Employer's Phone #:
*Employer's Address:
*City/State/Zip:

*Length of Time in Current Position:			*Length of Time in LTC:
FADONA/LTC member			Or, sponsored by member
*Sponsor Name:
*Facility Name:
*Facility Address:
*Type of educational degree seeking program in which applicant is currently enrolled or accepted:
*Name of school, college or university:
*Address of school, college or university
*Name of financial aid advisor:
*Phone of Financial Aid Advisor:
*Length of time enrolled in education program:			*Length of time until completion:
*Narrative: Please include a (300 words or less) essay which outlines "Why this nominee should be considered or the Imogene Ward Nursing Scholarship Award. "

By submitting this nomination, the nominator confirm that the nominee is enrolled in an accredited Florida nursing program. The nominee agrees that he/she will pledge a minimum of two (2) years, working full-time in long-term care, in the state of Florida. The nominee confirms that he/she has not won a FADONA/LTC scholarship award in this calendar year. The nominee understands that he/she may be interviewed over the telephone by the Scholarship Committee, or its designee(s).

Florida Association Director of Nursing Administration
200 Butler Street, Suite 305, West Palm Beach, FL 33407
(561) 659-2167 * Fax: (561) 659-1291 * www.fadona.org