Doctoral Nursing Student Scholarship
Application Form
Name _____________________________________________________________
Address ___________________________________________________________
___________________________________________________________
Cell phone /Telephone # ____________________ Daytime # ____________________
Email Address ______________________________________________________
Doctoral Nursing Program Information
School Name _______________________________________________________
Program of Nursing Chair ____________________________________________
School Address _____________________________________________________
___________________________________________________________
School Telephone # __________________________________________________
Type of Nursing Program
EdD DNP PhD
Other________________
Date of Enrollment in the Nursing Program _____________________________
Expected Date of Completion ________________________ GPA ____________
Certification and Release of Information
I affirm that the information provided is complete, accurate, and true to the best of my knowledge. I
authorize school officials to release the requested academic information to the Kentucky Nurses
Association for the purpose of determining scholarship eligibility.
Applicant’s Signature ________________________________ Date ____________
Kentucky Nurses Association (KNA) Doctoral Nursing Student
$10,000 Scholarship Application Criteria and Process
The KNA Doctoral Nursing Student Scholarship is a scholarship awarded to
a doctoral nursing student who pursues a project / dissertation dedicated to
one of the following areas and that coincides with the priority platform
issues and projects of the Kentucky Nurses Association:
1.
2.
3.
PRACTICE: related to any areas of nursing and focus on practice;
EDUCATION: related to the advancement of nursing education in terms of
curriculum or faculty development;
OTHER AREAS RELEVANT TO THE HEALTH OF THE COMMONWEALTH OF
KY: this category is an open field that can relate to practice, education, research
or any other component of nursing that can be shown to impact the health of
residents of Kentucky
The Kentucky Nurses Association scholarship selection committee will give
priority to projects that relate to the following topics that comprise
the KNA 2015 platform priority issues:
1. A School Nurse in Every Kentucky School;
2. Geriatric health needs in Kentucky;
3. Transition To Practice – Paving a smoother transition from school to work for
new RNs;
4. Access to Care – improving access to care, especially preventative care, for
underserved populations;
5. Increasing the number of nurse educators in Kentucky;
6. Expanding the KNA voice of nursing in policy and legislation
Scholarship Application Criteria
To be eligible for this KNA Doctoral Student Scholarship, an applicant must be a KNA
member (and maintain that membership for at least two years following the completion
of the doctoral program), enrolled in a doctoral program (showing evidence of
acceptance in the program), have chosen a chairperson for his / her doctoral committee
(at the student’s university), have successfully completed a Masters in Nursing, and must
agree to meet monthly with a KNA designated mentor. The first $5,000 of the
scholarship will be awarded at the beginning of the first semester during which the
project begins. The second installment of $5,000 will be awarded at the beginning of the
second semester of the project, providing the doctoral student has completed the first two
semesters of work, as defined by the project timeline. The student must agree to meet
with the designated KNA mentor, monthly or more often, as requested by the KNA
mentor, and provide a written report of the first year’s progress.
KNA Scholarship Application Packet 2015
Scholarship Application Process and Timeline
1) Complete the application cover form, as well as a Enrollment Verification Form
from the student’s university doctoral program, and project chair.
2) Application form and accompanying information to the Kentucky Nurses
Association and Scholarship Committee must be postmarked by
September 15, 2015. Applications postmarked after that date will not be
considered by the review committee.
3) The accompanying information must include:
 A two page written description of the student’s doctoral project /
dissertation. This description should include background of the problem,
with evidence based support for problem solution. This project / dissertation
may address one of six areas (as given above), in order to be considered for
the $10,000 scholarship
 Letters of support of the project/dissertation by two (2) members of the
student’s program of nursing faculty, with one identified as chair and mentor
willing to work with a designated KNA mentor.
 A signed/dated agreement statement that commits the scholarship recipient
to write a publishable paper summarizing his / her project, as well as a
presentation (poster or oral) to a designated KNA / ANA event within 2
years of the scholarship receipt. The doctoral student must credit KNA’s
association with the project / dissertation. (Agreement is included below)
 The 2015 KNA Scholarship Awards will be presented to the recipients
during the Kentucky Nurses Association Education Summit on October 2,
2015 at Embassy Suites Hotel, 1801 Newtown Pike, Lexington, KY 40511.
The recipients and the program of nursing chairpersons will be notified in
advance in order to arrange for attendance at the awards ceremony.
4) Mail the completed application and attachments to:
The Kentucky Nurses Association Doctoral Nursing Scholarship
PO Box 2616
Louisville, KY 40201-2616
KNA Scholarship Award Agreement
1. Submission of a publishable article summarizing the results of the doctoral
project / dissertation. The recipient must acknowledge KNA’s association
with the project, in any published paper reporting on his / her doctoral project
/ presentation; AND
2. Preparation of a poster session for display or oral presentation at either a
designated KNA or ANA event. The recipient must acknowledge KNA’s
association with the project, in any published paper reporting on his / her
doctoral project / presentation.
KNA Scholarship Application Packet 2015
I affirm that if I am a selected recipient of a 2015 Kentucky Nurses Association
Scholarship, I will participate in the process of informing others about the scholarship
program and process by completing both the publishable paper and poster / oral
presentation within 2 years of the scholarship receipt.
Applicant Signature __________________________________ Date _________
KNA Scholarship Application Packet 2015