2023 Care Initiatives Director of Nursing (DON) Scholarship Form

2023 Care Initiatives Director of Nursing (DON) Leadership Scholarship

This scholarship is for directors of nursing (DONs), assistant directors of nursing (ADONs) or registered nurses (RNs) interested in pursuing an ADON or DON position with an IHCA, ICAL or ICHC member organization. Six scholarships will be offered to provide for up to $1,500 toward tuition or registration fees to attend eligible leadership programs offered by an Iowa community college or eligible education provider. Scholarship applications are due by May 31, 2023.

Applicant Information

Applicant Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

Employer Information

Is your employer a member of the Iowa Health Care Association?(Required)

Yes

Employer Company Name(Required)

Employer Address(Required)

Street Address Address Line 2 City State ZIP Code

Administrator/Director's Name(Required)

First Last

Administrator/Director's Phone(Required)

Administrator/Director's Email(Required)

Applicant's Job Title(Required)

Number of Years Applicant Has Worked in Long-Term Care(Required)

Month/Year of Hire at Current Employer(Required)

Educational Program Information

Please select the eligible leadership program you are enrolled in.(Required)

If you selected other to the question above, please explain the leadership program here.

Expected Program Completion Date (Month/Year)(Required)

Other IHCA Foundation Scholarship Applications

If you are applying for additional IHCA Foundation scholarships this year, please select all of the scholarship types for which you are applying. (Check all that apply)

John W. and Kimberly D. Grubb RN SCHOLARSHIP

MolinaCares HIGH SCHOOL SCHOLARSHIP

IHCA Member EMPLOYEE SCHOLARSHIP

Iowa Total Care LEADERSHIP INSTITUTE SCHOLARSHIP

Linda Juckette Family VETERAN AND RURAL SCHOLARSHIP

Required Documents

Essay(Required)

Max. file size: 50 MB.

Compose and upload an essay of 500 words. It must be your own work and include discussion on the following: 1.) The reason you have selected long-term care as a career field and your work history in long-term care (i.e., nursing facility, assisted living facility or home health agency), including any supervisory experience or future anticipated supervisory duties. Please include the number of direct reports you have directly supervised and the scope of your supervisory responsibility. 2). Describe your career goals specific to long-term care (i.e., nursing facility, assisted living facility or home health agency). 3.) Describe how you plan to apply what you learn from the leadership training covered by the scholarship to your work in long-term care. Describe how this leadership program will improve or enhance your current supervisory skills and outcomes.

Letter of Recommendation(Required)

Max. file size: 50 MB.

Upload one letter of recommendation from your administrator/director or manager. Please ask them to include your name, their name, organization name, telephone and email address in the letter. Also in the letter, ask them to describe why they believe you would be a worthy recipient of an IHCA Foundation scholarship. Please limit letters to 200 words or less.

Scholarship Award Terms, Conditions + Terms of Agreement

Terms and Conditions(Required)

Upon being awarded the scholarship, a recipient is required to execute any and all documents IHCA determines are necessary, including but not limited to a promissory note. If the scholarship recipient does not complete the educational program during the time frame for which scholarship funds are provided, any unused funds are to be returned to the IHCA Foundation. If awarded the scholarship, the scholarship recipient agrees to remain employed with an IHCA member organization and to complete 1,500 hours of work for that organization following the completion of the educational program funded by this scholarship. If the scholarship recipient voluntarily terminates employment with an IHCA member organization, or is terminated by the IHCA member organization for cause, before working the required number of hours, the recipient agrees that within 30 days of termination the recipient will reimburse the IHCA Foundation in the amount of the scholarship on a prorated basis based on the number of work hours actually completed following the completion of the education program as follows: 1,125-1,499 hours completed = Reimbursement required in an amount equal to 25% of the total scholarship awarded to the recipient, 470-1,124 hours completed = Reimbursement required in an amount equal to 50% of the total scholarship awarded to the recipient, 375-469 hours completed = Reimbursement required in an amount equal to 75% of the total scholarship awarded to the recipient, Less than 374 hours completed = Reimbursement required in an amount equal to 100% of the total scholarship awarded to the recipient. This scholarship is not intended nor in any way should it be construed as an obligation by the IHCA member organization to employ or continue to employ the recipient. If awarded the scholarship, the scholarship recipient grants IHCA permission to publish any information provided in the scholarship application for scholarship fundraising purposes and to use the recipient’s likeness in any photograph or video in any and all of its publications, including television commercials, print advertisements, website and social media entries without payment or any other consideration.

Yes, I agree to the terms and conditions.

No, I do not agree to the terms and conditions.

Terms of Agreement(Required)

I certify with my initials below that I meet all the requirements for a student in good standing at an approved educational institution and that I meet all the eligibility requirements for the scholarship for which I am applying. I certify that all the information contained herein is true and correct. I further certify that I have read, understand and agree to the Scholarship Award Terms and Conditions, including but not limited to the reimbursement requirements set forth therein in the event that I fail to complete the required number of work hours following the completion of the education program.

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