Primary Care Scholars Program Application

This program is for Nurse Practitioner 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 program in one of our primary care nurse practitioner tracks are encouraged to apply. Students accepted into the Graduate Nursing Education Primary Care Scholars Program (GNEPCSP) proceed through the MSN 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.

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
Invalid Input

Zip Code(*)
Please include your zip code.

Home Phone
Please enter/correct home phone number.

Cell Phone
Please enter/correct cell phone number

E-mail(*)
Invalid email address.

Race/Ethnicity(*)
Invalid Input

Date of Birth(*)
Please include your birthday.

mo/day/yr

Gender(*)
Invalid Input

Please select which graduate nursing specialty track you have applied or been accepted for admission. If other, please specify below.

Graduate Education
Invalid Input
Other Graduate Education
Invalid Input

Select the semester you did/will enroll in the NP program.

Enrollent Semester
Invalid Input

What year did/will you enroll in the NP program?

Enrollment Year
Invalid Input

What is your anticipated graduation date from the NP program? (month/year)

Graduation Date
Invalid Input

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

Obligation
Invalid Input

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

Practice County
Invalid Input

Do you speak any languages other than English?

Other Languages
Invalid Input

Would you consider yourself 'disadvantaged'?

Disadvantaged
Invalid Input
 

Describe your personal and professional experiences to date (community service, volunteer and paid experiences) and how they relate to your future plans to practice as a primary care NP in rural Alabama. Please limit to no more than 1 typed page.

Invalid Input

List any prior work or education experience you have had in providing care to rural or medically underserved populations. Please limit to no more than 1 typed page.

Invalid Input

Describe your goals/reasons for applying. Why do you want this experience? Please limit to no more than 1 typed page.

Invalid Input

How will the GNEPCSP contribute to your future career as a primary care NP? Elaborate on your anticipated future practice. Please limit to no more than 1 typed page.

Invalid Input
Date(*)
Invalid Input

Acknowledgement(*)
Invalid Input

 

Printed Name
Invalid Input

Please click the check box(*)
Invalid Input