Scholarship Application

Please fill up the form below
First Name
Last Name
Address
City
State
Zip
Contact Phone
Work Phone
Email Address
SGNA/RMSGNA membership dates
Current Certification
GTS certificate
Number of Years
Intended use of Funds
Concisely state three course objectives or personal goals
GI-related community service/participation
Past or Present RMSGNA/SGNA office or committee involvement
Have you received and RMSGNA scholarship in the past? NoYes
If  so, when?
RECIPIENT RESPONSIBILITIES

  • I will attend the entire program for which I receive scholarship funds.
  •  I will submit actual documentation of the use of the funds along with a copy of the attendance certificate for the course scholarship within three months of the course.
  • I will submit an overview of what I have learned at the educational event to the education committee within three months of the course.
  • If responsibilities are not met, I realize I will not be eligible to receive future RMSGNA scholarships.

I agree to the above scholarship recipient responsibilities.