Dee Bauer Scholarship Application

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This scholarship is meant to help school nurses attend OSNA conferences. Before completing this application, please review the Dee Bauer Scholarship Guidelines

Name

Address (mailing) *

Phone number *

Number of years of membership in OSNA *

Email address *

Employer/school district's name *

Title (District Nurse, School Nurse...etc.) *

Purpose for requested funds (name of event) *

Briefly describe how this class/event will enhance your nurse practice in the school setting: *

Have you accessed this fund previously? If yes, when? *

I verify that I am an active member of OSNA in good standing for at least one year and agree to maintain my membership and practice school nursing for at least one year following the receipt of funds should I be awarded this scholarship. *

I agree

I disagree

I verify that I have not accessed the Dee Bauer Fund within the past 5 years. *

I agree

I disagree

I understand that up to 50%, and no more than $200 of the conference tuition is available through this scholarship, and I will be responsible for funding the remaining cost of attending the event. *

I agree

I disagree

I understand that the scholarship does not cover any cancellation fees incurred if I cannot attend. *

I agree

I disagree

I understand that these funds will be used for an OSNA conference only. *

I agree

I disagree

Required

Please write your full name below, which acts as a signature that all information provided is accurate to the best of your knowledge. *

Submit

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