OREGON CANCER REGISTRARS ASSOCIATION
MICHELE HENSON MEMORIAL SCHOLARSHIP FUND
APPLICATION FORM
Name
Credentials
Institution
Phone
_____________________________________________________________________________________
Address
City, State, Zip
Number of years employment or other involvement in a cancer registry:
Number of years membership in OCRA:
NCRA:_____________________
You must attach:
1)
A brief summary of your work experience, education, AND goals. You may include anything else you feel is
pertinent to this selection process.
2)
A letter from your supervisor stating that your employer will not pay the examination fees.
I certify that the information provided in this application is correct, and that:



I am an active member of the Oregon Cancer Registrars Association in good standing.
I am eligible to write the Certified Tumor Registrars examination according to NCRA criteria.
www.ctrexam.org
I am working full or part time in a cancer registry, which is part of a Cancer Program approved by, or striving
for approval by, the Commission on Cancer.
Signature of Applicant
Date
OCRA Standing Rule:
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Two scholarships will be awarded to OCRA members to cover the cost of the NCRA CTR exam.
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The amount of the scholarship will be equal to the exam registration fee.
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One scholarship will be awarded for the spring and one for the fall exam.
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The recipient will be notified the following month and announced in the newsletter.
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The recipient will be reimbursed upon submitting documentation to the OCRA treasurer that the NCRA CTR
exam has been completed.
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The selection will be based on a brief written summary of the applicant's experience, education, goals,
number of years as an OCRA member, and number of years employed or involved in a Cancer Registry.
Return completed application to:
OCRA Treasurer
DEADLINE FOR POSTMARK/FAX:
(Check which scholarship period you are applying for)
_____
SPRING EXAM
_____
ALL EXAM