2.Are you a member of PNWSGNA?YesNo (Disqualified from scholarship)
3.How long have you been a member of PNWSGNA? _____________________________
Application Questionnaire
4.Are you applying for another scholarship to attend the upcoming SGNA National Conference?
Yes, in the amount of:
_____________________
No
5.Have you received another scholarship to attend the upcoming SGNA National Conference?
Yes, in the amount of:
_____________________
No
6.Are you receiving any funding from your employer to attend the upcoming SGNA National Conference?
Yes, in the amount of:
_____________________
No
7.Have you ever attended the SGNA National Conference?
Yes
No
8.Are you applying for certification at the upcoming SGNA National Conference?
Yes
No
9.Have you received the Bette Schulenberger Memorial Scholarship in the past?
Yes, in the following years: _______________
No
10.Have you served on the PNWSGNA Board in the past 5 years?
Yes
No
Personal Statement
Please attach a brief Personal Statement that addresses the following points:
Your involvement in your workplace; your GI interest; your community activities; any publications; participation in educational activities (coordinating, planning, teaching, etc.)
Why you want to attend the conference (What are your goals for attending the conference?)
How this event will help you in your work
How you will share your experience with co-workers
Any other special circumstances (including financial hardship) that might bear on this application, if applicable
Terms of
Agreement
I understand that, if I receive a PNWSGNA Bette Schulenberger Memorial Scholarship, I am required to apply the funds received toward the registration expenses for the upcoming SGNA National conference Within 30 days following the course, I agree to: a) Submit a copy of my Certificate of Attendance to verify my attendance at the program; b) Submit documentation of my actual use of the scholarship funds; and c) Submit an article to be printed in the PNWSGNA newsletter, “The Lightsource.” I also agree to share information from this experience with my colleagues.I attest that all information provided in this application is true and accurate to the best of my knowledge and that I have met eligibility criteria for this scholarship.