Download application - Dermatology Nurses` Association

2017 Career Mobility Scholarship-Undergraduate Nurse
Purpose: To fund the continuing nursing education of a DNA member that will enhance his/her
ability to contribute to the dermatologic community.
Criteria: The candidate must:
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Be a DNA member for 2 years.
Be employed in the specialty of dermatology.
Be pursuing a degree in nursing; must be enrolled in a certified nursing program.
Currently be an LPN, Associate/Diploma prepared RN.
Must write an article for Focus within one year of winning award.
Submit: The candidate shall submit:
1. Letters of recommendation from peers and professionals who have knowledge of the
applicant's commitment to dermatology nursing and the DNA.
2. A detailed letter stating:
a) Professional goals.
b) Course of study proposed.
c) Time frame for completion of study.
d) Funds necessary to meet educational needs.
e) Statement of need.
3. A completed awards application.
4. Documentation of enrollment at a school of nursing.
5. Documentation of involvement with DNA in the past 2 years.
Award: The recipient will be awarded a $1000 educational scholarship to assist in the pursuit of
a nursing degree.
DNA Recognition Program Application
Complete separate application for each award/grant/scholarship
Award/Grant/Scholarship:____________________________________________________
Nominee:_________________________________________________________________
Address:__________________________________________________________________
Phone: (H) __________________ (W) _________________ Email: ___________________
CRITERIA – Please check, describe, and include dates of all that apply. Attach extra pages
if necessary. Include documentation such as copy of degree, certification, and other proof of
participation.
1. Education (document all degrees)
2. Certification:
 Dermatology Nursing:
 Other Nursing:
 Other:
3. Years Active DNA Membership:
 1-2 years
 3-4 years
 5-7 years
 8-9 years
 10 years or greater
4. Dermatology Experience:
 1-2 years
 3-4 years
 5-7 years
 8-9 years
 10 years or greater
5. Professional Associations:
 DNA National Office
 Other Organization National Office
 DNA National Committee Chair
 DNA National Committee Member or Appointee
 National Convention Moderator or Guide
 DNA Local Chapter Involvement
 DNA Local Chapter Officer/Chair
 Committee Member DNA
 Membership in professional organizations other than DNA
 (State Nurses’ Association, Sigma Theta Tau, other specialty)
 Officer/Board Member, local level, other professional organization
 Committee member other professional organization
6. Professional Volunteer Activities for the last 5 years: (not limited to these examples)
 Skin cancer screenings:
 Health fair activities:
 Community health events:
 Special camps or other health camps:
 Other:
7. Community Volunteer Activities for the last 5 years:
 Civic/community service activity:
 Church/Synagogue related activities:
 Other:
8. Professional Presentations/Publications:
 National – DNA:
 National – other:
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Regional/local – DNA:
Regional/local – other:
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National Journal – Author JDNA:
National Journal – Author other:
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Published Book – Author:
Published Book - Editor:
Published Book – Contributing Editor:
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Reviewer – DNA:
Reviewer – other:
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Newsletters – DNA Focus Editor/Author:
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Other
Other
Other
Other
– Videos:
– Pamphlets:
– Internal teaching tools (staff or patient):
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9. Professional Awards/Honors/Grants/Scholarships:
 National:
 Regional/local:
 Other:
10. Specific Information: (please attach information per specific criteria)
APPLICATION MATERIALS MUST BE SUBMITTED AS SINGLE SIDED PAPER ONLY
Return application to:
DNA Recognition Program
435 N. Bennett Street
Southern Pines, NC 28387
Email: [email protected]
Fax: 910-246-2361