Select a Scholarship *

Bachelor Degree in Nursing

Master’s Entry Program Nursing (MEPN)

Advanced Degree (Master's, Doctorate, PhD)

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

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If you are in a baccalaureate nursing student or a MEPN (Masters Entry Nursing Practice) program please answer the following: *

Are you a member of the California Nursing Students' Association?

Yes

No

College Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Current Academic Institution Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Current Academic Status *

Bachelor of Science Nursing

Master Science Nursing / Master’s Entry Program Nursing (MEPN)

Doctorate Degree Nursing

Which year of your program are you currently in? *

First

Second

Third

Fourth

Confirmation of Information: *

I certify all of the above information to be true.