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Sigma Theta Tau Epsilon Xi Chapter
Spring 2024 Award Application
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* Indicates required question
Email
*
Your email
Untitled Title
Award for which you are applying (select one):
*
Jeanne T. Grace Excellence in Evidence Based Practice Award
Dissertation Award
DNP Scholarly Project Award
Education Innovation Award
Research Poster Award
Leadership Poster Award
Undergraduate Scholarship Award
First Name:
*
Your answer
Last Name & Credentials
*
(e.g., Doe, MS, RN-BC, CCRN)
Your answer
Professional Role, Title
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(e.g., Level III Nurse, Medical ICU, Highland Hospital)
Your answer
Mailing Address w/ Zip Code (for notification):
*
Your answer
Cell Phone (including area code):
*
Your answer
Employer (or list Full Time Student)
*
Your answer
Educational Preparation (select all that apply):
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Matriculated in BS in Nursing program (fill in where/when below)
Matriculated in Master's program (fill in where/when below)
Matriculated in Doctoral program (fill in where/when below)
Completed BS in Nursing (fill in where/when below)
Completed Master's degree (fill in where/when below)
Completed Doctoral degree (fill in where/when below)
Required
Current & Past Schools, and Dates
*
For matriculated students, enter your current school & anticipated graduation date; also enter previous degree(s) & date(s).
For graduates, please enter your previous degree(s) and date(s)
Your answer
Acknowledgement
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By clicking here I acknowledge that I understand that all supporting documents required for this application must be emailed to
EpsilonXi.URSON@gmail.com
by 11:59 pm on the due date listed on the award flyer.
Required
Signature:
*
Typing your full name below serves as the electronic signature that you attest to the completeness and accuracy of the information given on this form.
Your answer
A copy of your responses will be emailed to the address you provided.
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