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Nursing Degree Completion Scholarship

Genesis Health Services Foundation

Nursing Degree Completion Scholarship Application

Genesis Health System Employees Only


Click here to read the Eligibility Requirements and Terms of Scholarship.
Last Name:* 
First Name:* 
Middle Initial:* 
Employee Number: * 
Birth Date:* (i.e. 08/20/1986)
Address: *
City: * 
State: * 
Zip: * 
Day Phone:*
Evening Phone:*
Entity:*
Department/Unit:*
Job Title:*
Direct Bedside Care Giver?  Yes  No
Manager or Supervisor's Name:*
FTE Status: *
Years of Service:*
Email Address: *
Education Level: * ADN
Diploma
Non-nursing Degree
BSN
I am accepted into the following program: *(Nurse Practitioner programs do not qualify.)
BSN Completion Program Master's Degree Program
Number of credit hours remaining to obtain degree:
Cost per credit hour that my college charges:
Month and year that I expect to graduate with BSN
(not needed for MSN applicants):
What college/university are you attending
to attain your BSN or MSN?*
     College Address: *
     City/State/Zip: *
Genesis Committee Memberships:
(List most recent)
     Name of Committee:
     Dates of Service:
     Committee Chair? Yes No
     Name of Committee:
     Dates of Service:
     Committee Chair? Yes No
     Name of Committee:
     Dates of Service:
     Committee Chair? Yes No
     Name of Committee:
     Dates of Service:
     Committee Chair? Yes No
Professional Organizations: (List most recent)
     Name of Organization:
     Member since (date):
     Officer? Yes No
     Name of Organization:
     Member since (date):
     Officer? Yes No
     Name of Organization:
     Member since (date):
     Officer? Yes No
Genesis Department Preceptor?  Yes No
Special Genesis Projects: (List most recent)
     Project Name:
     Date:
     Presenter or Poster? Presenter Poster
     Project Name:
     Date:
     Presenter or Poster? Presenter Poster
     Project Name:
     Date:
     Presenter or Poster? Presenter Poster
Community Involvement (List most recent)
     Event Name:
     Date:
     Leadership Role? Yes No
     Event Name:
     Date:
     Leadership Role? Yes No
     Event Name:
     Date:
     Leadership Role? Yes No
Certification
     Name of Certification:
     Date Attained:
     Name of Certification:
     Date Attained:
     Name of Certification:
     Date Attained:
     Actively Pursuing Certification:

Essay
Please write a 500 - 600 word essay on how attaining a BSN or MSN degree promotes the ANA Standards of Professional Performance and the Magnet component of Exemplary Professional Practice or Pathway to Excellence Quality Program, as it relates to patient safety, ethical practice and quality care. (ANA Nursing Scope and Standards of Practice text available in the Genesis Library) and e-mail it to: scholarships@genesishealth.com