PHILIPPINE NURSES ASSOCIATION OF AMERICA, INC.

Nursing Scholarship Awards

Purpose:
The purpose of the grant is to provide opportunities to student nurses in the Philippines who
meet criteria to participate in the 2020 Filipino Nurses Global Summit III and 12th International
Nursing Conference and contribute to the nursing profession and the community, specifically
planetary health. Grants will be offered to students of reputable Schools of Nursing, especially
students with limited access to sources of funding. Recipients of the grant are expected to
report to the Selection Committee on how they were able to use their participation in the
conference to the benefit of nursing and/or their community.

Grant:
 The number of students supported will be subject to the availability of funds.
 If selected, the grant given to each student will cover the conference registration fee and
hotel accommodations.

Eligibility Criteria
 The applicant:
 Currently enrolled in a Bachelor of Science in Nursing (BSN) program at a reputable
school/academic institution in the Philippines with a weighted average (GWA) of 2.25 or
better on a 5-point scale
 Any nursing student may apply; but students in their junior or senior year are preferred.
 Annual family income of not more than one 750,000 Philippine pesos.
 Exhibits potential to contribute to nursing and the community.

Requirements:
The applicant will submit the following via the online application:
 True Copy of Grades indicating the GWA for all courses taken under the BSN program.
 Income Tax Return of Parents for year 2017 or verifiable documentation if income does not
warrant filing of income tax.
 Curriculum vitae or resume that includes contact information, educational background,
awards, involvement in school and community, and other relevant activities.
 Essay (250 words) articulating the value of attending the conference and scalable
contribution/s to nursing and/or to the community.
 Two letters of reference from:
 Faculty from current academic institution.
 Community Leader (e.g., religious leader, barangay leader, civic leader, professional
organization leader, etc.).
 Important Information
 The application for grant is online through Google Forms.
 If you do not have a Google account (i.e., Gmail), you need to create one before you can
continue with the application.
 Only submissions through the official Google Forms will be accepted for review. Any other
forms of submission (e.g., postal mail, email, fax, hand delivery, etc.) will not be accepted.
 Only one submission per applicant will be accepted. The first application as time-stamped
by Google Forms will be considered for review.
 PLEASE NOTE: Although you need a Google account (i.e., Gmail) to complete the online
application form, the email you provide in the online application form is where you will
receive confirmation of completing the form. You can enter the email address (e.g. AOL,
Yahoo, Gmail, Outlook, etc.) you frequently use/check. It is in this email where you will also
receive the notification of whether you are awarded the grant or not.
 To streamline the process, please read the instructions below to facilitate ease of
completing the application.
 Following the instructions is a copy of the actual online Google Forms for reference.
 The deadline for submitting applications is November 4, 2019 (Monday) at 5:00 a.m.
Philippines time.
Note: Around this time, the Google Forms will stop accepting online applications. The
Selection Committee will only accept applications that are time stamped on or before
the aforementioned time as generated by Google Forms.
 The Selection Committee is not responsible for late submissions or inability of applicant to
submit through Google Forms due to issues with user error, Wi-Fi, internet, Google
software (e.g., system is down), etc.
 Only documents with clear texts/images will be taken into consideration. Any documents
deemed unreadable, blurry, distorted, etc. by the Selection Committee will be excluded
from review.
 If selected as one of the recipients of the grant, each recipient will receive a Letter of
Congratulations from the Selection Committee Chair by December 7, 2019.
 A year after the event, i.e., January 2021, recipients of the grant are expected to write a
report (500 words in PDF or Word document) and submit it to the Chair of the Selection
Committee on how they were able to use their participation in the conference to the
benefit of nursing and their community. The written report will be emailed to
jenn.dizon@aol.com

Instructions
1. Since this is through Google Forms, you will be required to log in to your Google account
(e.g., Gmail) to complete the form. If you do not have an existing Google account, please
create one before proceeding.
2. All documents that will be uploaded to the online application must be in PDF files; except
for your headshot photo, it must be in a JPEG file.
 a. You are only allowed to upload one PDF file per type of document. Please make sure
you scan all your documents as PDF and save them as one single PDF file per type of
document.
b. Naming your files:
 All your file names should begin with your last name, followed by your first name,
and then the type of document.
 Examples: Juan.delaCruz_Essay
Juan.delaCruz_Recommendation.Letters.Faculty
Juan.delaCruz_Grades
Juan.delaCruz_Income.Tax
Juan.delaCruz_Photo
c. It is recommended to have a designated folder where you can save all your documents.
This will facilitate ease of uploading your documents to Google Forms.
3. Copy of True Grades:
a. Scan and save a PDF file of your True Copy of Grades following the naming format of the
examples above.
4. Annual Family Income:
a. Scan and save a PDF file of the Income Tax Return of Parents for year 2017 or verifiable
documentation if income does not warrant filing of income tax.
b. Follow the naming format of the examples above.
5. Curriculum Vitae/Resume:
a. Your curriculum vitae/resume should include contact information, educational
background, awards, involvement in school and community, and other relevant
activities.
b. Save curriculum vitae/resume as a PDF file following the naming format of the examples
above.
6. Essay:
a. The essay should address: “What do you plan to do with what you have gained/learned
in the conference for nursing, your school, or the community in general? List specific
activities”.
b. The essay should be no more than 250 words, one page, and double space. The essay
must include a title.
c. Save your essay as a PDF file following the naming format of the examples above.
7. Letters of Reference:
a. Request a Letter of Reference from your:
 Faculty member of current school/academic institution.
- Scan and save the document as a single PDF file following the naming format of
the examples above.
 Community Leader: E.g., religious leader, barangay leader, civic leader, professional
organization leader, etc.
- Scan and save the document as a single PDF file following the naming format of
the examples above.
8. Questions Pertaining to Your Achievements:
a. If you select “Yes”, you will be prompted to upload supporting documents pertaining to
each question.
b. If you select “No” you will be directed to the next question.
c. These achievements/activities must be within the past five year.
Note: The Selection Committee is aware that you may not be able to provide all of the
following documents; but these supporting documents will impact your overall score.
9. Academic Achievements:
a. These are academic-related achievements within the past five years.
b. Scan and save a PDF file of certificates/proof of academic awards following the naming
format of the examples above.

10. Non-Academic Achievements:

a. These achievements are related but not limited to sports, community, outreach, etc.
within the past five years.
b. Scan and save a PDF file of certificates/proof of non-academic awards following the
naming format of the examples above.
11. School Involvement:
a. These activities are related to sports, clubs, performing arts, etc. within the past five
years. You don’t/didn’t necessarily have excelled in these activities; although you need
to provide proof of active participation.
b. Scan and save a PDF file of certificates/proof of involvement in school activities (must
include role, name of activity, and date) following the naming format of the examples
above.
12. Community Involvement:
a. These are community-related activities (e.g., medical mission, Gawad Kalinga, etc.). You
don’t/didn’t necessarily have excelled in these activities; although you need to provide
proof of active participation.
b. Scan and save a PDF file of certificates/proof of involvement in community and other
relevant activities (must include role, name of activity, organizer, and date) following the
naming format of the examples above.
13. Your Photo:
a. You should be in your school uniform in your head shot photo.
b. If you are not in your school uniform, you will be required to resubmit a photo. Failure
to comply with this requirement will result in disqualification.
c. Save your photo in a JPEG file following the naming format of the examples above.
d. You will be required to sign a Photo Release Consent in the online application in Google
Forms.
14. You know you have successfully completed the application form when you see the message
below:
15. You will also receive a verification email (in the email you provided in the online application
form). Note that in the example below the email was sent to a Yahoo account as this was
the email provided in the online application form; despite the requirement to have a Google
account to complete the online form.

Link to the Online Application Form for the Student Grant

https://docs.google.com/forms/d/1s-
pOcM0CjH9onkW9kgM2VGHRRTJKI83eBmQH6AFi4
78/edit
For questions, please email Jennifer M. Dizon, DNP, RN-BC (Chair, Selection Committee) at
jenn.dizon@aol.com
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2020 Global Summit and International Nursing

Conference Attendance Grant (for BSN Students)
* Required

1. Email address *

2. First Name *

3. Middle Name *

4. Last Name *

5. Age *

6. Contact number (e.g. cell phone number) *

7. Name of School (No acronym; spell out) *

8. Location of School *
Mark only one oval.

Luzon
Visayas
Mindanao

9. Year level *
Mark only one oval.

Freshman
Sophomore
Junior
Senior

General Weighted Average (GWA)

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10. General Weighted Average for all units taken

under the BSN program (converted on a 5-point
scale with 1 as the highest). *

11. Upload a PDF file of True Copy of Grades indicating the GWA for all courses taken under the
BSN program. *
Files submitted:

Annual Family Income

12. Annual Family Income (In Philippine Pesos) *

13. Upload a PDF file of Income Tax Return of Parents for year 2017 or verifiable documentation if
income does not warrant filing of income tax. *
Files submitted:

Curriculum Vitae/Resume
14. Upload a PDF file of you curriculum vitae/resume. Your curriculum vitae/resume should include
contact information, educational background, awards, involvement in school and community,
and other relevant activities *
Files submitted:

Essay
15. Upload a PDF file of your essay, which addresses: "In 250 words, what do you plan to do with
what you have gained/learned in the conference for nursing, your school, or the community in
general? List specific activities." *
Files submitted:

Letter of reference from faculty member of current

school/academic institution.
16. Upload a PDF file of a letter of reference from a faculty member of your current school/academic
institution. *
Files submitted:

Letter of reference from community leader.

17. Upload a PDF file of a letter of reference from your community leader (e.g., religious leader,
barangay leader, civic leader, professional organization leader, etc.). *
Files submitted:

Academic Achievements
18. Do you have any academic achievements within the past five years? *
Mark only one oval.

Yes Skip to question 18.

No Skip to question 19.

Proof of Academic Achievements

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19. Upload a PDF file of certificates/proof of academic awards within the past five years. *
Files submitted:

Non-Academic Achievements
20. Do you have any non-academic achievements (e.g., achievements related to sports, community,
outreach, etc.) within the past five years? *
Mark only one oval.

Yes Skip to question 20.

No Skip to question 21.

Proof of non-Academic Achievements

21. Upload a PDF file of certificates/proof of non-academic awards within the past five years. *
Files submitted:

School Involvement
22. Are you, or have you been involved in any school-related activities (e.g., sports, clubs,
performing arts, etc.) within the past five years? *
Mark only one oval.

Yes Skip to question 22.

No Skip to question 23.

Proof of School Involvement

23. Upload a PDF file of certificates/proof of involvement in school activities (must include role,
name of activity, and date). *
Files submitted:

Community Involvement
24. Are you, or have you been involved in any community-related activities (e.g., medical mission,
Gawad Kalinga, etc.) within the past five years? *
Mark only one oval.

Yes Skip to question 24.

No Skip to question 25.

Proof of Community Involvement

25. Upload a PDF file of certificate/proof of involvement in any community-related activities (must
include role, name of activity, organizer, and date). *
Files submitted:

Photo
26. Upload a JPEG file of your photo; a head shot photo in your uniform. *
Files submitted:

Photo Release Authorization

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27. By affixing your complete name below, you

hereby grant permission to the PNAA to use
this digital photo in publications, news
releases, online, social media, and in other
communications related to any lawful business
of the PNAA without payment or other
consideration. You hold the PNAA harmless
and waive any claims for injury or
compensation resulting from the activities
authorized by this agreement. Furthermore, the
photo, as used in this agreement, shall mean
motion picture or still photography in any
format, as well as videotape, video disc, social
media, and any other mechanical means of
recording and reproducing images. Note: the
date of this electronic signature corresponds to
the date you submitted this electronic
application form. *

A copy of your responses will be emailed to the address you provided

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