SCHOLARSHIP APPLICATION 2015

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Daisy Booker
5 years ago
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1 GREAT LAKES CHAPTER INFUSION NURSES SOCIETY SCHOLARSHIP APPLICATION 2015 To be eligible for scholarship you must have been a member of INS for the entire 2014 year AND a current member of the Great lakes Chapter (dues paid for the year) The applications MUST be post marked for return by January 19, 2015 All supporting documentation MUST accompany the scholarship application. Mail completed application form to: Karen Lawrence Academy Roseville, MI 48066

2 GREAT LAKES CHAPTER INFUSION NURSES SOCIETY SCHOLARSHIP APPLICATION 2015 Date Received (For Committee Use Only) Eligibility for a scholarship is contingent upon qualified membership in the Infusion Nurses Society and the Great Lakes Chapter of INS. Individual(s) will receive financial assistance according to the budgeted funds. Incomplete applications will not be considered. Please enclose documentation to support your points. Name: Address: Home Phone Number: Business Phone Number: INS Number: Section 1: Appointed/Elected Offices: (Select either A or B, not both) A. Officer President GLC 1_ President-elect GLC 12 Points Secretary/Treasurer/Pres. Advisor GLC 10 Points B. Accepted nomination to Office Great Lakes Chapter Points earned 1

3 Scholarship Program Continued, page 2 Section 2: Committee Work: A. Committee Chairperson (If serving on a committee as chair, do not take points for the same committee as a member.) Great Lakes Chapter 10 Points each Great Lakes Chapter Subcommittee or Task Force Committee Name B. Committee Membership: (Must attend 80% of all committee meetings to receive credit.) Great Lakes Chapter Great Lakes Chapter Subcommittee or Task Force 3 Points each Committee Name Points earned page 2

4 Section III: Education/Authorship Scholarship Program Continued, page 3 A. Speaker at INS meeting Chapter Fall Seminar 10 Points each Bi-Monthly Meeting Meeting 1 CRNI Review Class Another INS Chapter meeting 2 Points each Meeting B. Authorship (submit an article) Chapter Newsletter (Clinically based, not a committee report) _ Committee report (Chair or Member) INS Journal _ Newsline Other Publications 2 Points each Article: C. Abstract: (Do not submit if submitted under IIIA.) Submission INS nationally sponsored meeting OR Acceptance and Presentation 10 Points each Points earned page 3

5 D. Educational Poster Scholarship Program Continued, page 4 Submission INS ly sponsored meeting OR Acceptance and presentation 7 Points each Section IV: Meetings/ Recruitment: A. Meeting Attendance January Banquet GLC March Meeting GLC May Meeting GLC July Picnic GLC Fall Seminar GLC November Meeting GLC Host a chapter meeting (Includes all INS members of the host facility) Facility Conference 3 Points each Conferences Academy May Academy November Item Writers Workshop Participation in Needlefest 3 Points 3 Points 3 Points Needlefest Points earned page 4

6 Scholarship Program Continued, page 5 Any other INS Chapter Conference 2 Points per conf. Conference B. Recruitment GLC Membership GLC - Bring a guest Guest Name 2 Points per guest Sponsor a New Member 5 Points per member New Member Name Section V: Certification and Recognition A. Certification Take the CRNI exam Pass the CRNI exam Current Certification (Copy of card) CRNI Review class attendance B. Honors or awards Great Lakes Chapter Member of the Year (Poster, Abstract, Etc.) Scholarship application points 5 Points per class Points earned page 5 Points earned Total points earned

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