American Nurses Association Massachusetts

Ruth Lang Fitzgerald Memorial Scholarship

The American Nurses Association Massachusetts Ruth Lang Fitzgerald Memorial Scholarship was established by the Fitzgerald family in memory Ruth Lang Fitzgerald, a founding member of American Nurses Association Massachusetts (formerly MARN) and a longtime member of the American Nurses Association, who passed away in January 2005. Ruth was proud of her 62 years as an RN, her service to her country during War World II as a 1st Lt. in the Army Nurse Corps in the South Pacific and her work as an advocate for seniors.

This scholarship of up to $1000 is to be given to a member of the American Nurses Association Massachusetts to pursue an area of interest or special project that will be beneficial to the member and/or the Association. The Scholarship may be used to attend an educational conference or some other educational activity. It may also be used for participation in a humanitarian aide project. The Ruth Lang Fitzgerald Memorial Scholarship is presented each year at the ANA Massachusetts Awards Dinner Ceremony in early spring. Scholarship recipients are asked to serve on the selection committee for the following year’s awards.

Eligibility / Selection Criteria

 Must be a member of ANA Massachusetts for at least a year (12 months).  Preference will be given to candidates who have current or prior military service; work or hope to work with a senior population; or who have an interest in legislative issues.  Must not have been a recipient of an ANA Massachusetts Award or Scholarship in a previous year.

Instructions for application completion & submission Application may be submitted electronically or by mail. Please complete all areas indicated with either text or check marks. For applications completed and submitted electronically, grey text boxes will auto expand to fit contents. Receipt of application submitted will be confirmed by email.

Completed applications should be sent to: [email protected] Or: Chair, ANA Massachusetts Awards Committee C/O ANA Massachusetts P.O. Box 285 Milton, MA 02186

Must be e-mailed or postmarked by January 12th.

American Nurses Association Massachusetts PO Box 285 ~ Milton, MA 02186 ~ 617-990-2856 www.ANAMASS.org Page 1 of 5 American Nurses Association Massachusetts

Application Form

Nominator Information

Name and Credentials: Address: City/State/Zip: Home phone (include area code): Home Fax: E-mail address:

Member of ANA Massachusetts since (month & year): Activities in ANA Massachusetts:

Have you had any prior military experience? yes no If yes, please indicate dates and branch of service:

Have you worked with a senior population? yes no If yes, please include the agency and dates worked:

Have you been involved with legislative issues? yes no If yes, please describe your experiences:

American Nurses Association Massachusetts PO Box 285 ~ Milton, MA 02186 ~ 617-990-2856 www.ANAMASS.org

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Funding Request

Name of Educational Activity / Conference:

Amount of Funding Requested (up to $1000): $

Please list the specific costs included in the funding request; registration, travel, books, etc.

If funding request is for conference attendance, please attach a conference brochure / flyer.

Name of Humanitarian Project:

Amount of Funding Requested (up to $1000): $

Please list the specific costs included in the funding request; registration, travel, books, etc.

Attach published information about the project.

A brief essay of not more than 250 words describing the conference / special project and your rationale including the professional benefit derived from this activity.

Signature (if mailed): Phone Number:

Print Name: Title:

Position: Date:

Are you a member of ANA Massachusetts?  Yes  No

Application Checklist

(Incomplete or partial applications will not be considered.)

Completed application includes:

 Personal Information Form

 Funding Request Form

 Essay

Completed application must be postmarked/submitted electronically by January 12th.