ABWM Foundation Scholarship Application

Scholarship Application Form
- Scholarships are open to candidates meeting the eligibility criteria for certification set forth by the American Board of Wound Management. Eligibility criteria are available here.
- Scholarships are available to first-time candidates.
- Scholarships are not available for retesting, rescheduling, or recertifying candidates.
Applicable Rules, Laws, and Regulations:

In accordance with Title VI of the Civil Rights Act, the ABWM Foundation scholarship does not discriminate based on race, ethnicity, or national origin.

The ABWM Foundation scholarship is a qualified scholarship, as the amount received will be used for the qualified exam expenses only. This is not considered taxable income.
I. Personal Data:

Tell us about yourself
Full Name*

First NameMiddle NameLast Name
Credentials
Organization or Employer*
E-mail :*
Where the confirmation will be sent
Phone Number
Home Address :

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please indicate which certification examination you will pursue.*

Certified Wound Care Associate® (CWCA®)Certified Wound Specialist® (CWS®)Certified Wound Specialist Physician® (CWSP®)
Have you been awarded any other wound care scholarships or grants?*

Yes (If so, please describe in candidate statement)No
If answered Yes, please specify:
II. Demographic Information:
What is your current area of practice?*

BSN – Bachelor of Science NursingCNA – Certified Nursing AssistantDO – Doctor of OsteopathyDPM – Doctor of Podiatric MedicineDVM – Doctor of Veterinary MedicineEDUC – EducatorLPN – Licensed Practical Nurse or Licensed Vocational NurseMD – Doctor of MedicineMEDTECH – Medical Technician or AssistantNP – Nurse PractitionerPA – Physician AssistantPT – Physical TherapistPTA – Physical Therapist AssistantRD – Registered DieticianRES – ResearcherRN – Registered NurseSMKT – Sales & Marketing
Other – Healthcare Professional (Please specify)
What is your practice setting?*

ClinicLong-term CareAcute CareHome Care
Other (Please specify)
III. Additional information:
This information may increase your likelihood of qualifying for the scholarship.
Are you a Veteran?*

YesNo
If answered Yes, What branch of the military or reserves did you serve in and what time period? (only applicable for Harold L. Johnson Memorial Scholarship).
IV. Candidate Statement
Your statement should be 300-500 words and should address the following points:
1. Describe your experience in wound care, highlighting your involvement and commitment to the field.
2. Explain, in your own words, how you demonstrate financial need.
3. Discuss your long-term career goals and aspirations, particularly in relation to wound care.
4. Highlight any volunteer work, personal qualities, or unique experiences that make you an outstanding candidate for scholarship consideration.
Candidate Statement:*

0/500
V. Required Documents
Resume or CV*

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A copy of the candidate’s most recent tax return *

Please include an explanation in your essay as to why there is financial need for the scholarship.
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VI. Applicant's E-Signature
I hereby certify that the information included on this appllication is accurate.
E-Signature:*
Date*

MonthDayYear
Date
Should be Empty:

Scholarship Application Form

I. Personal Data:

II. Demographic Information:

III. Additional information:

IV. Candidate Statement

V. Required Documents

VI. Applicant's E-Signature