FADONA's 20th Anniversary Convention

FADONA/LTC SCHOLARSHIP APPLICATION

APPLICATION REQUIREMENTS: 1) Currently a licensed RN, LPN, or certified nursing assistant (CNA); 2) CNA must be currently accepted or enrolled in a RN or LPN program; 3) LPN must be currently accepted or enrolled in a RN program or undergraduate health care management program; 4) RN must be currently accepted or enrolled in a baccalaureate or master’s program in nursing, gerontology program, undergraduate or graduate program in health care management, or nurse practitioner program; 5) A minimum of 2-years’ employment history in long-term care (LTC); 6) List names of employers and dates of employment history in LTC; 7) Member of FADONA/LTC or sponsored by a member of FADONA/LTC; 8) All application requirements met; and 9) There will be a minimum of $500 awarded with each FADONA/LTC scholarship, and they are paid directly to the college, university or accredited LPN school. Note: This application does not cover the Ward Scholarship Award.

REVIEW PROCESS: Each application is reviewed by the committee chairperson(s), and finalists will be forwarded to the committee for final selection. This process shall be completed quarterly, and the names of the selected individuals shall be presented to the FADONA/LTC Board and those who have provided the grants. Individuals who receive scholarships must agree to publication.

Name:
Social Security Number:
E-mail:
Address:
City/State/Zip:
Phone Number:
Fax Number:

Employer's Full Name:
Employer's Phone #:
Employer's Address:
City/State/Zip:

Length of Time in Current Position:			Length of Time in LTC:
Name of Supervisor:			Supervisor's Phone:
Name of Department Head:			Dept. Head Phone #:
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 minimum 100-word narrative describing the reasons you request a scholarship. You should include your goals and interest in pursuing a career in LTC.

By submitting this application, I indicate that I am a member of FADONA/LTC or am being sponsored by a member of FADONA/LTC, am employed in LTC, and plan on remaining employed in LTC for at least two years. Application should be submitted to the FADONA/LTC president who will forward it on to the scholarship chairperson. Application must be completed in full for any consideration.

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