MAR WOCN® Society - Scholarship Application

Mid Atlantic Region of the WOCN® Educational Scholarship Application Form

The MAR of the WOCN^® Scholarship Committee is proud to offer scholarship awards for those nurses wishing to attend an Accredited Educational Program. Scholarship applications are accepted once yearly and must reach the Mid Atlantic Region of the WOCN chair of the scholarship committee by midnight, August 1, 2024. Applications may be submitted before program begins.

No information, either via email or US mail, will be accepted after this time - no exceptions. It is the applicant's responsibility to assure that they have met all criteria and that all requested information has been submitted in full.

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Complete and submit this application form. (* Required Fields)

Applicant Information

Email: *

Confirm Email: *

Name - First / Last: *

Credentials: *

Street Address: *

City/State/Zip: *

Phone: *

Home Work Mobile

Identify the WOC program which you would like to attend

Program Name: *

Start/End dates: *

Program Description: *

Financial Impact

Expenses: *

Reimbursements: *

Have you been awarded any other awards, grants or scholarships?*

Yes No
If yes, enter amount:

Are you eligible to receive or have you received tuition assistance / reimbursement from your employer?*

Yes No
If yes, enter amount:

Financial Need Narrative: *

Explain your financial need / reason for requesting a scholarship

Employment History (begin with most recent)

(1) Employer Name

Location

From

Position/Title

Position Description:

(2) Employer Name

Location

From

Position/Title

Position Description:

(3) Employer Name

Location

From

Position/Title

Position Description:

Education Background (begin with most recent)

(1) Institution

City/St/Country

Graduated (mo/yr)

Degree Earned

(2) Institution

City/St/Country

Graduated (mo/yr)

Degree Earned

(3) Institution

City/St/Country

Graduated (mo/yr)

Degree Earned

Describe or provide examples of your contributions to professional and community organizations.

List continuing education courses, programs and/or other professional development activities related to WOC nursing you have completed in the last two years.

Write a brief summary of your long term career goals. Provide specific reasons for wanting to take this training.

Describe your professional and personal strengths and/or attributes that will enable you to achieve your goals and enhance your role as a WOC nurse.

Signature: *

In lieu of my signature, by checking this box, I hereby certify that this is a true and accurate representation of my information, activities and accomplishments.

Check to "sign"

Date:

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