2022 Doctoral Scholarship Application

General Information

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 Texas RN License Number (required)

Your Texas RN License Expiration (required)

Your ENA Member Number (required)

Your ENA Member Expiration (required)

Year of Initial ENA Membership (required)

Your Texas Chapter Membership(s) - Past Two Years (required)

University Information

Name of University (required)

Department Name (required)

Street Number and Name (required)

City (required)

State (required)

ZIP Code (required)

Phone Number (required)(no dashes)

Website (required)

Doctoral Program

Select your Program (required)
PhDDNPDNP/PhD

Number of Hours Enrolled for (next) semester/quarter/trimester. (required)

Synopsis of Dissertation Proposal or DNP Capstone/Terminal Project. Synopsis must clearly relate to emergency care that includes the scope of emergency nursing. 350 word limit. (required)

Statement of Post-doctoral Professional Goals Related to Emergency Care/Emergency Nursing. 200 word limit. (required)

Required Attachments

Curriculum Vitae (3MB file size limit)(required)

Professional Reference Letter from ENA Member - Include Member Number (3MB file size limit)(required)

Additional Professional Reference Letter (3MB file size limit)(required)

Required Attachments from University

Verification of ACEN or CCNE Doctoral Program or PhD Accreditation (3MB file size limit)(required)

Official Transcripts - Must Have University Seal/Verification (3MB file size limit)(required)

Program Director Letter (3MB file size limit)(required)

Degree Plan for your Doctoral Program - From University Catalog (3MB file size limit)(required)

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

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)

Signature (required)

Date (required)

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