Kent State University
College of Nursing
Psychiatric Mental Health Nursing (PMHN) Graduate Program
Application for Margaret Clark Morgan Foundation and/or
Ohio Department of Mental Health Traineeship
Graduate PMHN students may apply for a Margaret Clark Morgan Foundation/Ohio Department
of Mental Health traineeship. These traineeships will be available for the following semesters:
Fall 2012 and Spring 2013. Students must complete and submit an application for each
semester he/she is seeking traineeship funds. Eligibility criteria must be met and maintained.
The amount of the traineeship will depend on the number of qualified students who apply for
these funds.
Eligibility criteria are:
1.
Full acceptance into the MSN Program in one of the following three concentrations: PMH Adult
CNS, PMH Child/Adolescent CNS, PMH Adult or Family NP;
or,
Full acceptance into one of the following post-master’s certificate programs: PMH CNS Adult,
PMH CNS Child/Adolescent, or PMH Adult or Family NP.
2.
GPA 3.0 or above at the time of application
3. No outstanding incomplete grades on transcript at time of application.
4. Enrolled in full-time (minimum of 8 semester hours) or half-time (minimum of 4 semester hours)
graduate coursework.
5. Commitment to participate in volunteer mental health activities during the semester that the
traineeship is awarded.
6. Commitment to work in the Ohio mental health system after graduation.
Deadlines for completed applications are:


August 17, 2012 for the Fall 2012 Semester
January 4, 2013 for the Spring 2013 Semester
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Kent State University
College of Nursing
Psychiatric Mental Health Nursing (PMHN) Graduate Program
Application for Margaret Clark Morgan Foundation Traineeship
Name
Banner ID
Address (street)
(city, state, zip)
Email
Phone (home)
Phone (work)
Phone (mobile)
Undergraduate GPA
Current Graduate GPA
RN License Number
Expiration date:
State:
Indicate semester/academic year you are seeking funding for:
Fall 2012
Spring 2013
Indicate your program concentration:
Psychiatric Mental Health Clinical Nurse Specialist (Adult)
Psychiatric Mental Health Clinical Nurse Specialist (Child/Adolescent)
Psychiatric Mental Health Nurse Practitioner (Adult or Family)
Post-Master’s Certificate
Psychiatric Mental Health Clinical Nurse Specialist (Adult)
Psychiatric Mental Health Clinical Nurse Specialist (Child/Adolescent)
Psychiatric Mental Health Nurse Practitioner (Adult or Family)
Indicate all sources of financial aid (grants, scholarships, employer reimbursement) you are
currently receiving:
Type of Aid
Amount
2
Renewable (Y/N)
Indicate the courses you plan to take during semester for which you are seeking funding:
N60002
N60005
N60007
N60012
N60013
N60042
N60045
N60051
N60101
N60151
N60206
N60332
N60441
N60450
N60401
N60402
N60451
N61592
N65692
PMH APN Adult II: Group, Organization, Community
PMH APN Child/Adolescent II: Group, Organization, Community
Advanced Assessment Across the Lifespan
Advanced Mental Health Assessment and Psychopathology
Advanced Health and Physical Assessment Lab
Primary Care I
Pathophysiology for Advanced Practice Nurses
Neurobiology and Psychopharmacology Across the Lifespan
Theoretical Basis for Nursing Practice
PMH APN I: Individual Psychotherapy Across the Lifespan
Ambulatory Diagnostics for APN
CNS Role Practicum in PMNH
APN Pharmacology
Ethical and Cultural Issues
Research Methods I
Nursing Research II
Health Policy and Delivery System
PMH APN Practicum I
PMH Practicum III
Indicate your projected graduation date: ________________
Briefly describe the type of mental health volunteer activities you are interested in.
Formulate goals for your participation in these volunteer activities:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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If you receive traineeship funds, are you willing to:
practice in a mental health setting in Ohio for at least two (2) years following
graduation?
serve as a preceptor for students in the PMHN graduate program at Kent State
University?
serve as a guest lecturer on special clinical topics in courses offered in the PMHN
graduate program at Kent State University?
CERTIFICATION In the event I am awarded support, I hereby certify that:
1. I am enrolled full-time (8 semester hours) or part-time (4 semester hours) in the
PMHN graduate program at Kent State University
2. If my enrollment status changes due to dropping a course, I have until the end of the
semester to pay back the traineeship monies I received for the semester.
3. I know I must maintain a 3.0 GPA.
4. I consent to provide information regarding professional activity for 3 years following
graduation from the PMHN graduate program at Kent State University.
5. I know this is taxable income.
My signature demonstrates that all the information contained in this application is accurate
and current.
____________________________________________________ ________________________
Signature
Date
Mail completed application to:
Wendy Umberger PhD PMHCNS-BC
Program Director, PMHN Graduate Concentration
Kent State University
College of Nursing
113 Henderson Hall
Kent, OH 44242
or
Fax to:
330-672-2433
Attention: Dr. Wendy Umberger
or
Email to:
wlewando@kent.edu
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