MAOHN Scholarship Award

MAOHN Scholarship Award: Nominate

Instructions for Completing a Nomination for the MAOHN Scholarship Award

  1. You may submit a nomination for yourself or any MAOHN member that you feel is deserving of this honor.
  2. Complete all fields of this online application. If you do not have the information available to complete a field, please enter "UNKNOWN".
  3. Once you have completed all fields of information, click the SUBMIT button at the bottom of the page.
  4. You will receive an email confirmation of your submission once it has been received by MAOHN.

Submission for the MAOHN Scholarship Award

Nominee's Name*:

Nominee's Employer*:

Nominee's Current Job Position*:

Is nominee a licensed nurse with an active license in the State of Minnesota?  Yes    No

Is Nominee a current member of MAOHN?  Yes    No

Has Nominee been a member of MAOHN for two or more continuous years?  Yes    No

Has Nominee been employed as an occupational health professional for a minimum of two years full time or four years part time?  Yes    No

Describe the intended use of the Scholarship Award and the cost involved. If known or applicable, please state the name of the educational institution or organization providing the educational opportunity.

State educational and career plans, as well as the ways this award will help to enhance the nominee's role as an occupational health professional.

Please list the names and contact information for 3 references that can provide information about this nominee:

Reference Name:     Phone Number:

Reference Name:     Phone Number:

Reference Name:     Phone Number:

Submittor's Name*:

Submittor's Address:

Submittor's Phone:

Submittor's Email:

Submittor's relationship to nominee:

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