Primary Care Scholars Program Application

This program is for advanced practice registered nursing students who plan to provide primary care in one of Alabama's 55 rural counties upon graduation. Students aspiring to practice in rural Alabama who have been accepted into the MSN or DNP program in one of our primary care tracks are encouraged to apply. Students accepted into the Graduate Nursing Education Primary Care Scholars Program (GNEPCSP) proceed through the program as a cohort. Primary Care Scholars will enroll in the same courses as their classmates and will receive mentoring, individualized case studies and content relative to rural health issues, preceptorships with selected rural health providers and additional opportunities for professional development.

* required

Personal Information

First Name*

Please provide your first name.

Middle Name*

Please include your middle name.

Last Name*

Please include your last name.

Current Mailing Address*

Please include your address.

City*

Please include your city.

State*

Please include your state.

County

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Zip Code*

Please include your zip code.

Home Phone

Please enter/correct home phone number.

Cell Phone

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E-mail*

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Race/Ethnicity*

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Gender*

Please select from one of the choices above.

Date of Birth*

Please include your birthday.

Do you speak any languages other than English?*

Yes

No

Please select "Yes" or "No".

Would you consider yourself 'disadvantaged'?*

Yes

No

Please select "Yes" or "No".

Primary Care Scholars Program Application

This program is for advanced practice registered nursing students who plan to provide primary care in one of Alabama's 55 rural counties upon graduation. Students aspiring to practice in rural Alabama who have been accepted into the MSN or DNP program in one of our primary care tracks are encouraged to apply. Students accepted into the Graduate Nursing Education Primary Care Scholars Program (GNEPCSP) proceed through the program as a cohort. Primary Care Scholars will enroll in the same courses as their classmates and will receive mentoring, individualized case studies and content relative to rural health issues, preceptorships with selected rural health providers and additional opportunities for professional development.

* required

School Information

Please select which graduate nursing specialty track you have applied or been accepted for admission.

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If other, please specify below.

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What semester and year did or will you enroll in the NP program?

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What is your anticipated graduation date?

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Enter the Alabama county where you plan to practice upon completion of the NP program.

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Do you have an obligation to establish in a certain location or type of practice (rural, under-served, or military) upon graduation?*

Yes

No

Please select "Yes" or "No".

Primary Care Scholars Program Application

This program is for advanced practice registered nursing students who plan to provide primary care in one of Alabama's 55 rural counties upon graduation. Students aspiring to practice in rural Alabama who have been accepted into the MSN or DNP program in one of our primary care tracks are encouraged to apply. Students accepted into the Graduate Nursing Education Primary Care Scholars Program (GNEPCSP) proceed through the program as a cohort. Primary Care Scholars will enroll in the same courses as their classmates and will receive mentoring, individualized case studies and content relative to rural health issues, preceptorships with selected rural health providers and additional opportunities for professional development.

* required

Additional Information

Personal & Professional Experience

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Work or Education Experience

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Goals/Reasons for Applying

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Benefit

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Primary Care Scholars Program Application

This program is for advanced practice registered nursing students who plan to provide primary care in one of Alabama's 55 rural counties upon graduation. Students aspiring to practice in rural Alabama who have been accepted into the MSN or DNP program in one of our primary care tracks are encouraged to apply. Students accepted into the Graduate Nursing Education Primary Care Scholars Program (GNEPCSP) proceed through the program as a cohort. Primary Care Scholars will enroll in the same courses as their classmates and will receive mentoring, individualized case studies and content relative to rural health issues, preceptorships with selected rural health providers and additional opportunities for professional development.

* required

Acknowledgement of Authorization Verification

Acknowledgement*

I acknowledge that the above information is correct and complete and I hereby authorize verification as required by the School of Nursing.

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Today's Date*

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Printed Name*

Please provide you printed name.

Please click the check box*

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Primary Care Scholars Program Application

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Primary Care Scholars Program Application

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Primary Care Scholars Program Application

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Primary Care Scholars Program Application

Acknowledgement of Authorization Verification