American Association of Nurse Anesthetists
Foundation
Doctoral and Post Doctoral
Fellowship Program
Application
Sponsored by Merck
Deadline – October 31
American Association of Nurse Anesthetists Foundation
222 S. Prospect Avenue, Park Ridge, Illinois 60068
Phone: 847-655-1170 / Fax: 847-692-6968
www.aanafoundation.com
Section 1
Personal Data, Eligibility Statement and Release Form
Complete this application to apply for an AANA Foundation Fellowship (typewritten only). Return all
required application materials to: foundation@aana.com. The subject line of your e-mail must
read: Fellowship Application.
Date of Application: ____________________________
Name :
AANA # :
Credentials:
Current Position:
Facility/Business Name:
Address:
City, State, Zip:
E-Mail Address:
Cell Phone #:
Home Address:
City, State, Zip:
Home Phone #:
Fax #:
Name of University:
___________________________________________________________________________
Only Doctoral Fellows complete this information:
Name/Address of Chairperson:
Doctoral Degree Sought:
Anticipated Date of Graduation (indicate month/year):
Describe where you are in your academic program toward degree completion (less than 50
words):
If applying for the research doctorate fellowship, please indicate if you have received the award in
a previous year: Yes _____ Year _____
No _____
All Must Sign Below
By sending this page with my application, I attest that all the information is accurate. Please insert
an electronic signature.
Section 2
Name:
________________________________________________
Page 2 of 8
Date:
_______________________
The application fee is $50.00 for the first Fellowship Application and $10.00 for each additional
Fellowship Application. You can pay for your application fee at
http://www.aana.com/myaana/AANABusiness/aanafoundation/Pages/Dean-Hayden-andFellowship-Application-Fee-Transfer.aspx via credit card or by mailing in a check.
I am applying for:
(Please check all of the boxes that apply.)
Post Doctorate Fellowship
Research Doctorate Fellowship
Practice Doctorate Fellowship
The overall goal of the Fellowship Program sponsored by Merck is to:
 Cultivate the development of leaders in research within nurse anesthesia
 Encourage CRNAs to pursue a program of research
 Equip CRNAs with the skills to be leaders in research
 Recognize exceptional academic ability and leadership
 Establish a network of talented researchers
 Support a strong research commitment
 Funding is to be used to support an academic course of study and/or a target research
project
Postdoctoral Fellowship
Criteria:
 AANA member
 CRNA with a doctoral degree
 Demonstration of a strong commitment to nurse anesthesia
 Desire to develop a program of research or evidence-based practice model in a chosen
specialty area
Funding:
 1 - 2 fellowships; maximum of $40,000 award
Practice and Research Doctoral Fellowship (Six fellowships available)
Criteria:
 AANA member
 CRNA pursing a practice or research doctorate
 Demonstration of a strong commitment to conduct research, including research application
 Demonstration of a strong commitment to nurse anesthesia
 Desire to develop a program of research or evidence-based practice model
Funding: (Six fellowships available)
 Clinical Doctorate – maximum of one time $10,000 award
 Research Doctorate – maximum of one time $10,000 award
Page 3 of 8
Section 3
Student Involvement and Accomplishments
Organization, Community Service, Publications, Awards
Involvement and Accomplishments (description of activities in the past 5 years)
A.
Organization(s)
Name:
National/Regional/Local:
B.
Community Service
Name:
National/Regional/Local:
C.
Publications
Title:
Involvement :
(Member/Committee/Elected
Office)
Involvement:
(Member/Committee/Elected
Office)
Author(s):
D.
Award(s) (Must be related to nurse anesthesia only)
Title:
Recipient(s):
Page 4 of 8
Date of Publication:
Date of Award:
Fellowship Application Deadline Date: October 31
Incomplete applications will not be reviewed!
To apply for the AANA Foundation Doctoral or Post Doctoral Fellowship Program, e-mail all
items to foundation@aana.com. The subject line of your e-mail must read: Fellowship
Application. Item #8 below must be sent in separately. Post Doctoral applicants are not
required to submit items #5 and 6. Send all documents as Microsoft Word attachments;
please do not send PDF files. (Exception: Items #5 and 6 may be PDFs).
1. A complete, typed or computer generated application form – Pages 2, 3 and 4 above
2. A Curriculum Vitae
3. An abstract or proposal of research, including a budget (limit 15 pages). (An additional
maximum of two pages of references is permitted.) IRB is required before funding is distributed.
If you have IRB approval or exemption, please include the document.
4. A 300-word essay describing your current involvement in nurse anesthesia education, practice,
and/or research. Describe your future program of research and how this funding will support
you as a leader in research.
5. A copy of doctoral degree transcripts (Doctoral applicants only. (Must show cumulative GPA)
6. A copy of your entire program of study to earn your doctoral degree (Doctoral applicants only)
7. A 500 word essay showing research proposal progress, use of funds from previously awarded
doctoral fellowship, and justification of need for additional funds (previous recipients of the
Research Doctoral Fellowship only)
8. Minimum of two letters of reference (One from chairperson if doctoral applicant)
These letters must be sent directly from the reference’s business email address.
9. You can pay for your application fees at:
http://www.aana.com/myaana/AANABusiness/aanafoundation/Pages/Dean-Hayden-andFellowship-Application-Fee-Transfer.aspx
10. You will need to be logged on to the AANA website to access the payment form.
11. The application fee is $50 for the first fellowship and $10.00 for each additional fellowship.
12. Type the total number of fellowships you are applying for in the specified field. The total fees
will be calculated for you. (Your fellowship will not be processed until the fees are paid.)
13. Please fill out your credit card information and click on “Submit.”
14. If sending in a check for the application fee, please make the check out to the AANA
Foundation Doctoral Fellowship Application and mail it to AANA Foundation, 222 S. Prospect
Ave., Park Ridge, IL 60068.
15. If you have any questions, please call the Foundation number at 847-655-1170.
*Note: The Board of Trustees reserves the right to reject an application without review if any of the
components are missing or unsatisfactory.
Selection Process: The Professional Development and External Research Committees of the
AANA Foundation will review applications. Applications will be reviewed on a competitive basis
with a focus on the quality and relevancy of the research proposal. The Committee's
recommendations will be forwarded to the AANA Foundation Board of Trustees for a final decision.
Page 5 of 8
Research Funding Priorities
The AANA Foundation will give funding priority to the following topics:





Science of anesthesia
Education
Practice
Leadership
Healthcare policy
Prior to submitting your application for the AANA Foundation Fellowship Programs, check off the
following items to ensure all the necessary components are completed.
Checklist
_____ Completed application form – Pages 2, 3 and 5 above
_____ Curriculum Vitae
_____ Abstract or proposal of research project, including a budget
_____ A 300 word essay
_____ Copy of transcripts counting toward doctoral degree (Doctoral applicants only)
(Must show cumulative GPA)
_____ Copy of program of study (Doctoral applicants only)
_____ An additional 500-word essay showing research proposal progress and use of
funds (applies only to previous recipients of the Research Doctoral Fellowship)
_____ Minimum of two (2) letters of reference (must be sent directly from the reference’s
business email address)
_____ Application fee of $50.00 for the first application and $10.00 for each additional
application
_____ E-mail items to foundation@aana.com
_____ Do NOT SEND PDF files (does not apply to transcripts or study program)
Deadline: October 31
Page 6 of 8
Evaluation Tool
Name: ________________________________________________________________
Type of Degree Pursued: __________________________________________________
Please circle: Dissertation or Project
Title of Dissertation or Project: ________________________________________
Expected Date of Graduation: ________________________________________
Scoring System
Section 1: Proposal
_____ A focus on strength, relevancy, and budget (Score 0-30 points)
_____ Letters of Recommendation (Score 0-2 points)
Section 2: Professional Accomplishments
_____ Progress toward Degree Completion (Score 0-20 points)
_____ Leadership Roles (i.e., committee chair or officer positions, committee membership) (Score
0-15 points)
_____ Publications (Score 0-15 points)
_____ Professional Organization Memberships (Score 0-8 points)
_____ Current GPA (Score 0-5 points) (Transcript must show cumulative GPA)
_____ Awards (Score 0-5 points)
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ___
_____ Section 1: Proposal Score
_____ Section 2: Professional Accomplishments Score
_____ Total Score
Page 7 of 8
Previous Recipients Evaluation Tool
Name: ________________________________________________________________
Type of Degree Pursued: __________________________________________________
Please circle: Dissertation or Project
Title of Dissertation or Project: ________________________________________
Expected Date of Graduation: ________________________________________
Scoring System
Section 1: Proposal
_____ Focus on strength, relevancy, and budget (Score 0-30 points)
_____ Proposal Progress (Score 0-5 points)
_____ Letters of Recommendation (Score 0-2 points)
Section 2: Professional Accomplishments
_____ Use of Fellowship Funds (Score 0-5 points)
_____ Justification for Additional Funds (Score 0-5 points)
_____ Progress toward Degree Completion (Score 0-15 points)
_____ Leadership Roles (i.e., committee chair or officer positions, committee membership) (Score
0-10 points)
_____ Publications (Score 0-10 points)
_____ Professional Organization Memberships (Score 0-8 points)
_____ Current GPA (Score 0-5 points) (Transcript must show cumulative GPA)
_____ Awards (Score 0-5 points)
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ___
_____ Section 1: Research Score
_____ Section 2: Professional Accomplishments Score
_____ Total Score
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