[Email to a friend]

Tell Us About Yourself!

We welcome your application for the 2010 - 2011 HealthLinx Leadership Scholarship Program. Questions regarding the program should be submitted to leadershipinquiries@healthlinx.com.

Personal Information

First Name
Last Name
Middle Initial
Email
Phone
Address
City
State	Select Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachussetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming
Zip

Professional Information

Current title:
Facility:
Specify Service Line:	Women's & Children's/NICU/PICU/Pediatrics Medical-Surgical/Critical Care/ICU/CV Emergency Services Quality/Case Management/PI/Risk/Education/Research Surgical Services Oncology/Imaging Services
Years as an RN:	Select Less than 1 Year 1-5 Years 6-10 Years 11-20 Years More than 20 Years
Degrees and/or Certifications:
Years of Nurse Management or Leadership Experience: (Must have at least one year)	Select 1-3 Years 3-5 Years 5-10 Years 10-15 Years 15+ Years
Next Desired Position:

Education Information

What school are you attending?
Which degree are you seeking?:
Enrolled/Enrolling date:	Select January February March April May June July August September October November December   Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Select 2007 2008 2009 2010 2011
Expected graduation date:	Select January February March April May June July August September October November December   Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Select 2009 2010 2011 2012 2013

Other Information

Identify your top 3 strengths.	Accountability Active listening Analytical Command Communication Competition Financial savvy/business acumen Futuristic Harmony Input Learner Maximizer Positivity Relator Responsibility Self-assurance Strategic Team building
How did you hear about the HealthLinx Scholarship Program?	Select HealthLinx consultant email or call Referral from colleague or employer HealthLinx Web site Web search Publication Other Other:

Short Essay Questions

Describe your career development. (300 words or less)
Describe your top 3 career accomplishments and how they have contributed to the delivery of patient care and the development of nursing leadership. (300 words or less)
Describe your specific career goals and how they support the advancement of nursing leadership. (300 words or less)
What is the single biggest reason why you are pursuing an advanced degree? (50 words or less)
Additional comments. (optional, 50 words or less)

Submit Resume
(optional)

Copy/Paste resume here.