DNIF - Southwest Nursing Committment Scholarship Application

Southwest Nursing Commitment Scholarship Application
Overview

Please ensure you have read the guideline pages attached before and while filling out your application. Incorrect or incomplete applications will not be considered for funding. If you have any questions about this application form, contact the Foundation office at (306) 778-3314.
Application Type
Full Name

First NameMiddle NameLast Name
Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
I confirm the above email is correct
SOCIAL INSURANCE NUMBER (S.I.N.)

PROGRAM INFORMATION
ENROLLMENT INFORMATION

Please identify the degree program you have been accepted into or are currently enrolled in. Indicate the date your 3rd or 4th year program commences (starts) and when it will end, or your scheduled graduation date.

Please note: You MUST include proof of enrollment in 3rd or 4th year studies and proof of completion of your 2nd or 3rd year. If you wish to be considered for funding for another year, you will be required to submit a new application considered for the scholarship again. Call the Foundation office at 306-778-3314 for clarification if required.
COLLEGE/UNIVERSITY
PROGRAM
CERTIFICATE/DESIGNATION (upon completion)
PROGRAM YEAR
Scheduled Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Scheduled COMPLETION Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
EXPENSES

The Southwest Nursing Committment Scholarship is designed to support the costs of tuition and books related to the courses/classes being taken during the year.

All requests for financial assistance must be supported by documentation confirming the estimated cost of tuition & required books. SNCS does NOT support travel or living costs.

For Example:

a) Exam Costs relative to the classes being taken are eligible for support however the travel costs associated with attending a specific examination site are not eligible.

b) The cost of training materials (books; notes etc.) are eligible for support; however, any specialized equipment, tools, clothing, shoes etc. that must be purchased relative to the program and/or subsequent employment are not eligible for support.

Any application that is received that does not include sufficient information/documentation to confirm the costs of the program will be rejected.
TUITION/REGISTRATION COST
MATERIALS AND BOOKS COST
DOCUMENTATION

Confirmation of Enrollment / Proof of Completion / Program Costs Documentation

Please upload:
- Confirmation of enrollment for 3rd or 4th year studies
- Proof of completion of 2nd year or 3rd year studies
- Documentation to confirm program costs
Alternatively you can send these files later via email to our office at office@dnif.ca indicating your name and the date you submitted this application.

NOTE: Your application will not be considered complete until necessary files are uploaded.
File Upload

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Please indicate what documentation we can expect to receive to support your application if not uploaded here. Remember, your application will not be considered complete until necessary files are uploaded.
EXPENSES
The Skills Enrichment Scholarship Program (SESP) is designed to support the costs of tuition and books related to the courses/classes being taken during the semester.

All requests for financial assistance must be supported by documentation confirming the estimated cost of tuition & required books. SESP does NOT support travel or living costs.

For Example:

a) Exam Costs relative to the classes being taken are eligible for support however the travel costs associated with attending a specific examination site are not eligible.

b) The cost of training materials (books; notes etc.) are eligible for support; however, any specialized equipment, tools, clothing, shoes etc. that must be purchased relative to the program and/or subsequent employment are not eligible for support.

Any application that is received that does not include sufficient information/documentation to confirm the costs of the program will be rejected.

EDUCATIONAL BACKGROUND
If you are currently enrolled in a program, indicate as ongoing. If you have just graduated from grade 12 or are currently enrolled in grade 12, please list expected graduation date.
HIGH SCHOOL
CERTIFICATE/DESIGNATION ACHIEVED
POST-SECONDARY EDUCATION

Please tell us of any POST-SECONDARY education undertaken to date other than your current nursing program
EDUCATION #1
INSTITUTION
PROGRAM
CERTIFICATE/DESIGNATION ACHIEVED
WHEN DID YOU STUDY HERE?
EDUCATION #2
INSTITUTION
PROGRAM
CERTIFICATE/DESIGNATION ACHIEVED
WHEN DID YOU STUDY HERE?
OTHER COURSES OR TRAINING COMPLETED
Please List (Most recent first)

CAREER BACKGROUND
Please list previous or current work experience or employment, volunteer work, or other community involvment.
Employement History
Volunteer Work
Community Involvement and Extracurriculars

ESSAY
Why should we support your application?

In 250 words or less, please share:
- Your reasons for becoming a nurse
- Why you would choose to stay in Southwest Saskatchewan, giving personal examples of why
- How would your work impact your community
Use of generative AI to write this essay is not allowed, and if suspected the application will be disqualified.
TELL US WHY WE SHOULD SUPPORT YOUR APPLICATION:

REFERENCES
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Upload Reference Letters

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COMPLETE APPLICATION
Date of Application

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Return for Service

As the intent of the SNCS is to assist individuals wanting to work within the healthcare industry and support the healthcare needs of the residents of Southwest Saskatchewan, each Approved Applicant will be required to sign a Return for Service Agreement. By signing this agreement, Approved Applicants will indicate their willingness to utilize the education/skills they obtain within the former Cypress Health Region for a minimum of 4 years.
If I am approved for funding, I agree to sign a 4 Year Return for Service Agreement
I certify that the information contained in this application is true and correct to my knowledge:
I hereby authorize the Dr. Noble Irwin Regional Healthcare Foundation Inc. to validate any of the information related to this application.
If I am approved for a Southwest Nursing Committment Scholarship, I hereby give my permission to the Dr. Noble Irwin Regional Healthcare Foundation Inc. to publish my name, place of residence and employment and the name of the program/course related to this application in written documents, publications or other type of media for purposes identifying approved applicants of the Southwest Nursing Committment Scholarship Program, to be used to promote the Foundation and the Program.
DIGITAL SIGNATURE*
By checking this box, you are digitally signing this application and agree that all the information provided is accurate and complete.
Consent to Share Information
I, ____________________, give the Dr. Noble Irwin Regional Healthcare Foundation permission to share my information with other funding agencies.
Complete Application

After submitting application, a copy of this form will be emailed to you as a confirmation. Please do not send a paper copy via mail. Thank you for your interest. You will be contacted within a month after the application deadline.
Should be Empty:

Southwest Nursing Commitment Scholarship Application

Overview

PROGRAM INFORMATION

EXPENSES

EDUCATIONAL BACKGROUND

OTHER COURSES OR TRAINING COMPLETED

CAREER BACKGROUND

ESSAY

REFERENCES

COMPLETE APPLICATION

Return for Service

DIGITAL SIGNATURE*

Consent to Share Information

Complete Application