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

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1227 E. Rusholme Street Davenport, IA 52803 563-421-1000