Conference Scholarship Request Form
Please fill this out for all scholarship requests EXCEPT NSSRH Annual Activist Conference. Please DO NOT use this form to request funds for NSSRH Conference.

A limited number of scholarship up to $250 are available to members of active NSSRH chapters. Scholarship awards of less than $250 may be awarded.

Members of active NSSRH chapters are eligible for one award of up to $250 per fiscal year (July 1-June 30).

You will be notified of your award via email. Please complete the Scholarship Award Letter of Acceptance that will be attached to your award notification email, and submit, along with receipts for registration or travel, to cassandra@nssrh.org.

Your award will then be mailed to you.

After the conference, please complete the Conference Report Form that will be emailed to you, and submit photos to NSSRH. Failure to compete this form will make you ineligible for future awards. Photos and quotes from this form may be used in NSSRH grant and promotional materials.

Questions? Email Cassandra Belson, Program Director at cassandra@nssrh.org.

Your First Name: *
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Your Last Name: *
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Your email address: *
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Your phone number: *
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Your chapter affiliation: *
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Your degree program and school: *
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Your date of birth:
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Mailing address (where would you like a check mailed?): *
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To what conference/activity are you seeking assistance (please include dates and locations, unless restricted, such as NAF): *
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Emergency contact information (Name, relationship, email, phone number and type [cell, home, work]): *
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Total estimated travel costs: *
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Total registration costs: *
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Total amount you are requesting: *
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Mission: NSSRH is a national grassroots organization dedicated to providing nursing students with the education, tools, and resources necessary to become social change agents within the healthcare system as it relates to sexual and reproductive justice. Vision: Nurses are frontline health care practitioners and educators, and access to reproductive and sexual health for patients is a primary nursing responsibility. To prepare nurses for this critical role, NSSRH: i) ADVOCATES for comprehensive sexual and reproductive health education–including abortion training–for all nursing students; (ii) CREATES and SUSTAINS an effective, nationwide network of nursing student activists, alumni, allies, and mentors as champions of reproductive and social justice; committed to the elimination of racial, social, and economic inequities; (iii) SUPPORTS nursing students as leaders, experts, and advocates within social justice movements and reproductive healthcare; (iv) EMBRACES reproductive and social justice so that the nursing profession represents the diverse populations we serve, and to affirm the nursing profession as one that supports and nurtures patients and nurses from all races, ethnicities, abilities, religions, genders, gender expressions, ages, and sexual orientations; (v) PROVIDES a courageous environment that encourages open and honest dialogue on topics of diversity and social justice as a way to challenge students to examine their own social and cultural identities and their responses to systems of oppression, power, and privilege. With the NSSRH Mission in mind, briefly tell us how this conference supports the NSSRH mission. *
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How will your attendance at this conference affect you or your future practice? *
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Please be aware that if you receive funding, you will be required to complete the NSSRH Conference Scholarship Reporting Form. In addition to some basic details about the conference, you will be asked to write a short piece (2-3 paragraphs) describing the conference and some things you learned. Please share a photo or two from each conference as well. This write up (and photos) may be used on our website or other media. You will be emailed the NSSRH Conference Scholarship Reporting Form shortly after you attend the conference you are applying for. Failure to complete this form will result in ineligibility for future funding. By clicking agree below, you are acknowledging that you agree to complete the reporting requirements: *
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