1 Start 2 Complete First & Last Name * Preferred Title * Mr. Ms. Mrs. Dr. Other DNP Concentration * Anticipated graduation date * Email address * Phone Number * Street Address * City * State * Zipcode * County of Residence * Residence Type * Permanent Current Date of Birth * Are you currently employed in nursing? * Yes No Are you employed full-time or part-time? * Full-time Part-time Place of employment * Specialty area * What is the highest degree you have completed at the time of this application? * Do you currently live or work in a rural community? * Select all that apply Yes, I live in a rural area Yes, I work in a rural area No Are you from a rural area? * Yes No Have you previously lived in a rural area? * Yes No Have you worked in any of the following areas? * Select all that apply Emergency Services ICU Psychiatric Services Health Department Rural Health Facility Women's Health School Health Medical Surgical Other None List all certifications that you hold at the time of this application * Do you consider yourself to be economically disadvantaged? * According to HRSA, the following are characteristics that describe individuals who are considered Economically Disadvantaged: --Individuals who come from a family with an annual income below a level based on low-income thresholds according to family size published by the U.S. Census Bureau, adjusted annually for changes in the Consumer Price Index and adjusted by the Secretary of HHS. --Individuals who are considered as coming from a low income family. The Secretary of HHS defines a “low income family” for various health professions and nursing programs including Titles III, VII and VIII of the Public Health Service Act as having an annual income that does not exceed 200 percent of the Department of HHS poverty guidelines. A family is a group of two or more individuals related by birth, marriage, or adoption who live together or an individual who is not living with any relatives. --Students who received a Federal Pell Grant. Yes No Do you consider yourself to be environmentally or educationally disadvantaged? * According to HRSA “environmentally disadvantaged” means “an individual’s environment inhibited him/her from obtaining the knowledge, skills, and abilities to enroll in and graduate from a health professions school” and “educationally disadvantaged” means “an individual who comes from a social, cultural, or educational environment that has demonstrably and directly inhibited the individual from obtaining the knowledge, skills and abilities necessary to develop and participate in a health professions education or training program.” The following is a list of common characteristics that describe individuals who are environmentally/educationally disadvantaged. The examples are provided as guidance only, and are not intended to be all-inclusive: --Person from high school with low average SAT/ACT scores or below the average State test results --Person from a school district where 50 percent or less of graduates go to college --Person who has a diagnosed physical or mental impairment that substantially limits participation in educational experiences --Person for who English is not his or her primary language and for whom language is still a barrier to academic performance --Person who is first generation to attend college --Person from a high school where at least 30 percent of enrolled students are eligible for free or reduced price lunches Yes No Are you a Veteran? * According to HRSA, a “veteran” is any person who served in one of the seven uniformed services in the United States. The seven uniformed services include: 1- The United States Navy 2- Army 3- Air Force 4- Marines 5-Coast Guard, 6- Public Health Service 7- National Oceanic and Atmospheric Administration Commissioned Officer Corps Yes No Write a brief description why you would like to participate as a Student Scholar on the HRSA ANEW Grant. * ANEW Grant Requirements * If selected as a student scholar on the 2026-2027 ANEW grant, you agree to complete the following additional learning requirements: 1. Fall 2026- (date TBD)- In-person, on UTHSC Campus, all day Mental Health First Aid Training 2. Spring 2027- (date TBD_ In-person, on UTHSC Campus, all day 3. Complete 8 Rural Health Medallions: Introduction to Virtual Care, Rural and Underserved Nurse: Communication Module, Rural and Underserved Nurse: Health Policy Module, Cultural Sensitivity and Humility Module, Rural and Underserved Nurse: Health Literacy Module, Trauma-Informed Primary Care Module, Critical Thinking and Clinical Judgment Module, Social Drivers of Health Module Yes, I agree to all of the learning requirements No, I do not agree to the learning requirements Leave this field blank
