2018 Annual Conference Educational Grant Application

Boston Chapter of American Association of Neuroscience Nursing 2018 Annual Conference Educational Grant Application

Name: Address:

Email: Telephone:

Employer: A.A.N.N. Membership #

Are you actively working as a neuroscience nurse? Y N Position:

Are you a member of the Boston AANN Chapter? Y N

Have you attended a Boston Chapter meeting or activity? Y N Dates:

Have you attended a Boston Chapter conference? Y N Year/s:

Have you presented at a Boston Chapter conference? Y N Year/s:

Have you attended the AANN National conference? Y N Year/s:

Have you presented at the AANN National conference? Y N Year/s: Title/s:

Will you be presenting at the 2018 National conference? Y N Title/s:

Are you a past or present Board/committee member Y N Year/s: of AANN? Position:

Do you have active certification in Neuroscience Nursing? Y N

Do you have active certification in Stroke Neuroscience Y N Nursing?

Have you given a Neuroscience nursing presentation in the past year? Y N Title/s:

In the past year have you:

Conducted nursing research? Y N Title/s:

Authored/co-authored a nursing publication Y N Title/s:

I agree to present a review of the 2018 AANN conference at a Boston Chapter meeting.

Signature: Date:

 Please attach a short paragraph explaining why you should receive this scholarship.

 You must be present at the Brain Matters Conference November 8, 2017.  Application must be emailed by October 30, 2017 to [email protected]

 Contact Mary Guanci with questions at email above or call 1-857-238-5649