Certification Scholarship Application
American Board of Certification for Gastroenterology Nurses
Improving quality of patient care by advancing knowledge and validating a
professional’s commitment.
The ABCGN Recertification Scholarship has been established to financially assist candidates for
recertification by contact hours. Scholarships will be awarded each November, the number of
scholarships awarded will depend on funds available.
Application Deadline:
Spring Exam: November 1
Fall Exam: April 1
Candidates will be notified by email before the registration period opens for the exam
period they are applying for.
Eligibility:



The candidate must be currently working in the field of gastroenterology and have an interest in
and commitment to gastroenterology nursing.
Support the goals and philosophy of SGNA
Must have current RN license
Revised 07-15
Certification Scholarship Candidate Information
Name: ________________________________________________________________________________________________
Address: ______________________________________________________________________________________________
City: _________________________________________
Sate: _________
Zip: _____________
Email: ________________________________________________
Phone: ____________________________
I will be taking the exam:
☐
Fall
(October 1 – 31)
☐
Spring
(May 1 – 31)
Office Use
Only
Number of Years in Gastroenterology Nursing
SGNA membership length of time
0
years ☐
<5
years ☐
Yes ☐
2-4
years ☐
2-4
years ☐
5-10
years ☐
Number of years certified in Gastroenterology
(only applicable if recertifying)
Is this your first time taking the Certification
Exam?
Number of times you have attended
the Item Writers Workshop
0☐
1☐
2☐
Number of times you have attended
the SGNA Annual Course
0☐
1☐
2☐
Have you lectured on a GI related
topic in the last 5 years? If so, how
0☐
1☐
2☐
many times?
How many regional meetings and/or
courses have you attended this
0☐
1☐
2☐
year?
Have you served on a National SGNA committee in the last 5 years?
Have you served on a Regional SGNA committee in the last 5 years?
Have you served as a chair of a National Committee in the last 5
years?
Have you served as a chair of a Regional Committee in the last 5
years?
Have you served as a National SGNA officer in the last 5 years?
Have you served as a Regional SGNA officer in the last 5 years?
Are you certified in another Specialty?
Are you a member of another National Nursing Organization?
If yes, please list other nursing organizations
1.
2.
3.
Have you written an article published in the National or Regional
newsletter?
5-9
years☐
5-9
years ☐
10-15
years ☐
No ☐
10+
Years ☐
10+
years ☐
15+
Years ☐
3☐
4+ ☐
3☐
4+ ☐
3☐
4+ ☐
3☐
Yes ☐
Yes ☐
Yes ☐
4+ ☐
No ☐
No ☐
No ☐
Yes ☐
No ☐
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
☐
☐
☐
☐
☐
Yes ☐
☐
☐
☐
☐
☐
No ☐
Revised 07-15
Have you written an article published in a Nursing Journal?
Have you published a chapter in a health care journal or book?
Have you presented a poster on the National or Regional level?
Have you presented or displayed a Nursing Research Project?
Have you published a Nursing Research Project?
Are you actively involved in a Health related support group?
Are you a Gastroenterology preceptor?
Do you get Financial Support from your Employer or Regional for
recertification?
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
☐
☐
☐
☐
☐
☐
☐
☐
No
No
No
No
No
No
No
No
☐
☐
☐
☐
☐
☐
☐
☐
Please submit your answers to the following questions:
1. Explain why you want to get certified /recertify?
2. Briefly explain your professional goals in gastroenterology for this upcoming year?
Revised 07-15