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Tuesday, July 02, 2024   10:22 PM    |   88°F

CNE Academy Submission

Instructions

Upon completion of the CNE Academy program and final evaluation, please review the stipend eligibility criteria below. If you meet the criteria, please submit the required documentation for verification and enrollment into the grant. Upon verification, you will qualify for the respective stipends below as funds allow per grant year.

Stipend 1 Eligibility Criteria:

  1. Final NCPD certificate indicating completion of the Clinical Nurse Educator Academy
  2. Unrestricted nursing license in at least 1 of the HHS region 6 states (Louisiana, Texas, Arkansas, New Mexico, Oklahoma)
  3. Verification of nursing practice within the HHS region 6 states (link to template - download to computer, fill out, and upload below)
  4. Submission of a signed W-9 (link to form - download to computer, fill out, and upload below)


First:
Middle:
Last:
E-Mail Address:


Program Certificate:

 (.docx, .doc, and .pdf only)

License Verification:

 (.docx, .doc, and .pdf only)

Verification of Nursing Practice:

 (.docx, .doc, and .pdf only)

Signed W-9:

 (.docx, .doc, and .pdf only)

I am a preceptor referred by the ANEW grant: