IENA SCHOLARSHIP INFORMATION & APPLICATION FORM Consistent with the goals of supporting nursing education in District 4, as well as supporting members of the Association, the Inland Empire Nurses Association will award $1,000 scholarship(s) annually to nursing students who are AAS, BSN, MSN, PhD or Doctorate program candidates.Criteria for RN Applicants Hold a current, unrestricted Registered Nurse license. Member of WSNA/IENA in good standing. Has successfully completed at least one year of an accredited online or campus-based AAS, BSN, MSN, PhD or Doctorate program. Currently carrying a minimum GPA of 3.0 in current nursing program. If applying for specialty certification, items 3 and 4 above do not apply. Demonstrated commitment to nursing as a profession as evidenced in applicant’s Goal Statement and in letters of recommendation. Criteria for Basic Degree Applicants Has successfully completed at least one year in an accredited ADN or BSN program. Currently carrying a minimum GPA of 3.0 in current nursing program. Demonstrated commitment to nursing as a profession as evidenced in applicant’s Goal Statement and in letters of recommendation. Procedure 1. Submit a completed, typed Scholarship Application Form to be received no later than March 1, 2019 to the address below: Scholarship Committee Inland Empire Nurses Association 222 W Mission, Suite 231 Spokane, WA 99201 Alternatively, it may be submitted electronically by emailing it to the District office at admin@IENAnurses.org. 2. Arrange for two typed letters of recommendation to be received by the Scholarship Committee no later than March 1, 2019. The letters of recommendation should address the student’s work ethic and commitment to nursing as a profession. A current faculty member from the student’s school of nursing should write at least one letter. A faculty member or another professional colleague should write the other letter. 3. Submit a copy of the most current grade report including cumulative GPA. 4. Scholarship will be awarded at the Annual Spring Gala in May. 5. A Curriculum Vitae may be submitted in place of the academic education and professional experience sections of the Scholarship Application Form. IENA SCHOLARSHIP APPLICATION FORMPERSONAL DATAName First Last Email Address Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Cell phoneWork phoneHome phoneSchool of enrollment Expected graduation date - must be mm/dd/yyyy format MM slash DD slash YYYY Current GPA RN license number RN license expiration date - must be mm/dd/yyyy format MM slash DD slash YYYY ACADEMIC PREPARATION SINCE HIGH SCHOOLName of institution Location of institution Attended from - must be mm/dd/yyyy format MM slash DD slash YYYY Attended to - must be mm/dd/yyyy format MM slash DD slash YYYY Degree & Major Date - must be mm/dd/yyyy format MM slash DD slash YYYY Untitled Do you want to add more? Name of institution Location of institution Attended from - must be mm/dd/yyyy format MM slash DD slash YYYY Attended to - must be mm/dd/yyyy format MM slash DD slash YYYY Degree & Major Date - must be mm/dd/yyyy format MM slash DD slash YYYY Add More Name of institution Location of institution Attended from - must be mm/dd/yyyy format MM slash DD slash YYYY Attended to - must be mm/dd/yyyy format MM slash DD slash YYYY Degree & Major Date - must be mm/dd/yyyy format MM slash DD slash YYYY PROFESSIONAL EXPERIENCE (list most recent first)Name of agency Location of agency Dates employed Position Name First Last Describe your career goals. Please address your commitment to nursing as a profession.Describe your beliefs related to how and why the professional organization is important to nursing.Describe your participation in the professional nursing organizationThank you for your interest in the Inland Empire Nurses Association!