CCHT Career Mobility

CCHT, CCHT-A, & CD-LPN/LVN $2000 Career Mobility Scholarship Application

The scholarship provides funding for continuing education and development or support of a program to improve patient outcomes in the health science field. This funding enables NNCC certified clinical hemodialysis technicians, and NNCC certified dialysis - Licensed Practical/Vocational Nurses to grow and better contribute to the nephrology community. Please review this application form carefully before completion. For further information, contact: Kim Marrero of the NNCC National office at 888-884-6622 or email: [email protected].

THIS APPLICATION FORM IS AVAILABLE ONLINE AT WWW.NNCC-EXAM.ORG

Applicant’s Name & Credentials Job Title: Home Address City, State & Zip Daytime Phone Evening Phone Email Address For Term Beginning (mm/yy) Major (if applicable) Degree Objective Expected Graduation Date Preferred Mailing Address  Work  Home PLEASE COMPLETE CHECKLIST BELOW BEFORE SENDING APPLICATION

For Scholarship  One copy of completed application form  Essay of 250 words or less of career/education goals  Letter of acceptance from academic institution  Three letters of recommendation provided by the persons who can comment on applicant’s ability Please note funds will be sent by NNCC directly to the recipient’s designated school.

Please see next page for application completion instructions. Deadline: All application materials must be postmarked by November 30, 2015

NNCC National Office ~ Attention: Scholarships ~ East Holly Avenue, Box 56 ~ Pitman, NJ 08071-0056 For Fed Ex or UPS Mailing Address: 200 East Holly Avenue, Sewell, NJ 08080 APPLICATION COMPLETION INSTRUCTIONS

General Instructions (Selection is based on this information only):

1. Please provide the essay letter of application, relating to specific criteria for each scholarship. You must meet the scholarship criteria for your application to be considered. Submit typed copy only.

2. The scholarship funds will be disbursed directly to the institution attended by the recipient.

3. Recipient assumes all tax liabilities associated with the receipt of these funds.

4. All information is strictly confidential and will not be returned. Please furnish proper documentation and ensure that the information presented in your application packet can be verified independently by NNCC.

5. The scholarship winner will be notified by early March.

Completed application packet consists of:

1. One copy of the completed application form. This form is available online at www.nncc-exam.org.

2. One copy of your typed essay letter of application relating to the specific criteria for the award.

3. One copy of all supporting documents that are required for the scholarship such as a letter of acceptance from your institution/program, etc.

4. Three (3) letters of recommendation with one being from an immediate supervisor or manager.

DEADLINE: All application materials must be postmarked by November 30, 2015! Fax copies will NOT be accepted. Any monies awarded are subject to taxation. Please note incomplete applications will not be considered.