Helen Wilson Leadership Application 2021

Attestation Statement
I certify the provided information is accurate and true to the best of my knowledge and the material will remain the property of the Alabama Nurses Foundation. I understand that misrepresentation may result in forfeiture of the scholarship.

If I am awarded the scholarship, I agree to complete the nursing program specified and to work as a licensed registered nurse in Alabama for at least one year following graduation.

I certify that I am enrolled in the school of nursing I've listed below.

The Alabama Nurses Foundation does not discriminate on the basis of race, creed, color, national origin, religion, age, sex, handicap, disability, veteran status, marital status, sexual orientation, or any characteristic prohibited by law.
My school of nursing is: *
My anticipated date of graduation is: *
Type your full name below to certify the accuracy of the statements made on this page: *

Application
Name *

First Name Last Name
Student Identification Number *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
Personal Email Address *
example@example.com
College/University *
Address of college/university *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Briefly describe your participation in school and/or volunteer activities both in college and high school that demonstrates leadership. *
List honors and awards you have received and include nature of award and its relevance to nursing. *
Describe your current participation in AANA and how you what you anticipate your role to be in the professional organization after graduation. *
Briefly provide any other evidence of leadership achievements in nursing and/or the community.
Upload your official transcript (or mail to the address on page 1)

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2021 Helen Wilson Leadership Application