Last Name
First Name
Phone number
Email
UC Davis Job Title
  CRNA CNS NP PA
Is your position 0.6 FTE or greater? (Per Diem APPs are excluded) Yes No
Department
Clinical setting? Inpatient Outpatient Both
Years at UC Davis
Years practicing as an APP at UC Davis
Did you receive a Meets/Exceeds Expectations on your last performance evaluation? Yes No
Have you received a UC Davis APP scholarship in the past 3 years? Yes No
If yes, what year did you receive the scholarship?
Does your Department provide educational or conference funding for APPs? Yes No
If yes, list funding amount per year
1. Please state how you plan to use the scholarship fund (E.g., conference attendance, podium/poster presentation, specialty certification course and/or testing, advanced training course and/or testing, etc):
2. If scholarship funds are to be used towards a conference, please list conference name, date and location:
3. If attending a conference (in person or virtual), are you presenting department-related research at the conference (poster, abstract, other)? If yes, what is the title of your work? (Please click here (cddelemos@ucdavis.edu) to email us a pdf copy of your abstract, poster, other works)
4. How does the activity you wish to use scholarship funding for (listed in question 1 above) relate to your current advanced practice role at UC Davis Health?
Please complete section 5 & 6 if presented at a conference or will present at a conference:
5. Is this your first time presenting at a conference? If not, how many times you presented in your career?
6. If you have presented in the past, please provide a brief summary on past topics in which you have presented at a conference:
7. What leadership roles have you been involved in or are currently a part of?
8. Please list any professional organizations that you are a part of and how long you have been a member:
9. Please list any community or volunteer organizations that you are involved in and provide a brief description of each:
10. Please describe your academic/professional goals for the next 5 years (in 200 – 500 words):

Award and Frequency:
The purpose of the APP Education Scholarship is to help provide financial support towards APP professional development. The scholarships are awarded for one (1) year. The method, amount and schedule for processing applications will be determined by the APP Council.

Eligibility:

  • Must be a current UC Davis employee
  • Must have a current APP license
  • Must be working in an advance practice role at our institution
  • Applicants from all advance practice specialties are welcome to apply

Application requirement(s):

  • Please state how you plan to use the scholarship fund and how it relates to your current advanced practice role at UC Davis, Health (Examples: Conference attendance, specialty certification courses/testing, advanced training/courses) *Funds must be used by March 1st of the consecutive year following the award.
  • Applicants must provide proof of use of their scholarship fund (ie proof of registration for conference attendance, receipt of certification course) within two (2) weeks of accepting the award.
  • If awarded an APP Educational Scholarship, the recipient will present an overview to the APP Council at our meeting the month following the funded educational event or date.
  • All funds must be returned to the APP Council if the recipient is unable to attend the educational event or take the professional development course/testing.
  • Failure to follow these guidelines may lead to forfeiture of the scholarship.