Saskatchewan Nurses Foundation Bursary Application for CNA Certification Exam

Saskatchewan Nurses Foundation Bursary Application for CNA Certification Exam
Please submit this form directly to the Saskatchewan Nurses Foundation by clicking the submit button at the end. The application form and all necessary information must be received by September 30 of the year of application. Applications for which all needed documentation is not received by September 30 will not be considered. There is additional information provided for some items by hovering over the section of the form. In addition, the Application Guidelines will identify policies related to SNF bursaries and information for filling out the application form.
Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number. Do not leave a business number as calls are often made outside of business hours.
Email
example@example.com
I am currently licensed as a practicing registered nurse/nurse practitioner in good standing in Saskatchewan*

yesno
Please note: If you are not currently registered in Saskatchewan, you are not eligible for funding.

You must be registered as a practicing registered nurse or nurse practitioner in good standing.
CRNS registration number

Professional Nursing Experience

CNA Certification Examination Information
CNA Certification Specialty for which Bursary is requested
Applicants are eligible to receive funding at this level only for initial certification and only one time.
Date of Certification Exam

MonthDayYear
Date
Certification Number
Confirmation of certification*

Submit a copy of the letter confirming you have successfully passed the certification exam or a copy of your certification certificate. The letter or certificate should indicate the specialty in which you achieved certification.
Cancelof
Receipt of Payment*

Submit a copy of your receipt of payment for the certification exam.
Cancelof
I have not received funding for this certification exam from another source

Picture

Submit a photo (in .jpeg format) that can be used on the website and for publicity purposes.
Cancelof
Release of Information Form

Complete and sign the Release of Information form found on the SNF website. Submit it directly to the Foundation using the submit button found on that form. Remember that it must be submitted by Sept 30, 2023 in order for your application to be considered. If you do not receive a bursary, the form will be deleted.
Date

MonthDayYear
Date
By my signature below, I hereby declare that information furnished above is true and correct in every respect. Should any information be found incorrect, even partially, I understand that my application may be rejected or any bursary awarded may be revoked and may be required to be repaid.
Signature

Clear
Should be Empty:

Please note: If you are not currently registered in Saskatchewan, you are not eligible for funding.