The Canadian Orthopaedic Nurses Association
Association Canadienne des Infirmières et Infirmiers en Orthopédie

Continuing Education Award Application Form
Please print and complete this form, mail with supporting documents to the address below.

First

Surname
 Street

City
Membership No.
 Prov 
Postal code 
Phone (home)
()  - 
Phone (business)
()  - 
FAX
()  - 		 Years in CONA

Local Chapter or Member at Large

e-mail address

Please check off the award you are applying for.

Some awards require supporting data.  Please ensure these are included with your application.

Conference Grant
  • application form only

Stryker Excellence in Orthopaedic Nursing Practice
  • application form
  • two letters of recommendation

Canadian Orthopaedic Association Literary Award
  • application form
  • three copies of manuscript

DePuy Continuing Education Award
  • application form
  • two supporting letters

Dr. Robert B. Salter Award
  • application form
  • one supporting letter
  • four copies of research article

CONA Scholarships
  • application form
  • resume
  • academic transcripts
  • letter of acceptance or verification of enrollment
  • 2 letters of recommendation

CONA Speakers Fund
  • application form
  • resume
  • academic transcripts
  • letter of acceptance or verification of enrollment
  • two letters of recommendation

For Conference Grant Award Only:

Are you receiving any other financial assistance? YesNo        If yes, please specify:
Have you received funding before? Yes No        If yes, please specify:
How many National Conferences have you previously attended?

Orthopaedic Activities in the Last Five Years

Local Chapter Board position: 
Local conference committee member: 
Local Chapter conference committee member:
National conference committee member:
Hip Hip Hooray involvement:
Percentage of local continuing education meetings attended:   %

Please use the space below to outline your other contributions to the Orthopaedic Nursing and patient community (i.e. articles published, presentations given, guests brought to meetings, members recruited, fundraising activities, etc.)





Applicant Signature:
Date:
Local Chapter Executive Signature:
(or immediate supervisor for Member at Large)
Date:

Mail application and supporting data to:

Deb McCullough

12390 Oyama Road

Lake Country, BC

V4V 2A3

Or

e-mail: deborah.mccullough@ubc.ca

......... 

 
This page was last updated on 16 janv. 2008 .
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