2021 Special Scholarship Application

EN21 application deadline is Aug. 21, 2021. 

Please make sure you meet all of the eligibility and application requirements before completing this application.

This application must be completed in a single session as your progress will not be saved on this web page to be completed at a later time. Before submitting this application, review it to ensure that you have completed all necessary fields and uploaded all required documents.

All inquiries regarding application submissions should be directed to:
Gwen Medley, RN
2021 Scholarship Committee Chairperson
Email: scholarships@txena.org

    General Information - All applicants complete this section.

    Your First Name (required)

    Your Last Name (required)

    Your Credentials (required)

    Your Street Number and Name (required)

    Your City (required)

    Your State (required)

    Your ZIP Code (required)

    Your Email (required)

    Your Phone Number (required)(no dashes)

    Your ENA Member Number (required)

    Your ENA Member Expiration (required)

    Year of Initial ENA Membership (required)

    Your Texas Chapter (required)

    Years of Emergency Nursing Experience (required)

    What other financial support will you receive for this conference? (required)
    State CouncilChapterEmployerOther ScholarshipSelfOther

    Submit a short statement of financial need for a scholarship. (required)


    EN 21 Applicants Only

    Are you ENA Faculty?
    YesNo

    What is your Registration Preference?
    In personVirtual

    Have you Attended a previous ENA National Conference?
    YesNo

    Submit a Short Statement of Professional and Educational Goals for Attendance at EN 21


    Other CE Conference Applicants Only

    CE Conference Title

    CE Conference Sponsor

    CE Conference Location

    CE Conference Date(s)

    CE Conference
    ANCCOther

    Submit a Short Statement of Professional and Educational Goals Related to this Conference


    I agree to the following upon acceptance of Texas ENA scholarship funds:

    Monies granted shall not exceed the amount spent on the conference. The amount awarded will be determined based on submitted registration receipt.

    Initial: (required)

    I have reviewed this application and to the best of my knowledge the information submitted is accurate. It is understood the decisions as to whether any application qualifies me for approved funding rests solely and exclusively on the recommendations of the Texas Scholarship Committee, and their decision is final.

    Initial: (required)

    I understand that upon receipt of a scholarship that I will submit a synopsis (~100 words) of my education experience (e.g., favorite topic/content/speaker) to the Texas Newsrunner for publication.

    Initial: (required)

    Signature (required)

    Date (required)