Sample Application. 1. I am applying as a(n): Nurse faculty Auditor
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1 Sample Application Thank you for your interest in The Edmond J. Safra Visiting Nurse Faculty Program at the Parkinson s Disease Foundation. Before beginning the application, please have ready: your short statement of purpose; your CV; and two letters of reference. E L P Please note that this downloadable sample application is intended to give applicants a preview of the questions asked on our online application. We do ask that you apply online at in order for us to process your application. M A S 1. I am applying as a(n): Nurse faculty Auditor 2. To which program site of the Visiting Nurse Faculty Program are you applying? Miami, FL-February Baltimore, MD-May Philadelphia, PA-May Minneapolis, MN-June San Francisco,! CA-July Boston, MA-August Page 1
2 3. Please share the following information: First Name: Last Name: 4. Please share the following information: School of Nursing Affiliation: Primary Employer: Position/Title: Home Address: City/Town: State/Province: ZIP/Postal Code: Country: Address: Phone Number: 5. Please choose one or more to describe your ACADEMIC DEGREES: Ph.D. D.N.P. Ed.D. M.P.H. M.S.N. B.S.N. A.A. Other (please specify) Page 2
3 6. Please choose one or more to describe your CREDENTIALS: A.P.N. A.R.N.P. C.R.N.P. F.N.P. G.N.P. A.N.P. C.N.S. R.N. Other (please specify) 7. Why are you interested in attending the Visiting Nurse Training Program? Page 3
4 8. How did you hear about this program? Colleague (EJS Scholar) Colleague (non alumni) Conference from EJS program PDF newsletter PDF PDF website Brochure Other (please specify) 9. Please share a short narrative bio. If applicants are accepted, this information may be shared with fellow nurse faculty and program staff for The Edmond J. Safra Visiting Nurse Faculty Program at PDF. 10. Please upload your CV or resume here. When uploading, be sure to first click browse. Most file types, including.doc and.pdf, are accepted. Note: only complete applications will be considered. Applications submitted without all required documents will be considered incomplete. Page 4
5 11. Share the following information about your first reference, for someone who can comment on your interest and experience in Parkinson s. You will be asked to upload a letter from this reference on the next page. Name: Relationship to applicant: Title: Institute: Phone Number: 12. Please attach your first letter of reference here. When uploading your letters of reference, be sure to first click browse. Most file typles, including.doc and.pdf are accepted. 13. Share the following information about your second reference, for someone who can comment on your interest and experience in Parkinson s. You will be asked to upload a letter from this reference on the next page. Name: Relationship to applicant: Title: Institute: Phone Number: 14. Please attach your second letter of reference here. When uploading your letters of reference, be sure to first click browse. Most file typles, including.doc and.pdf are accepted. Page 5
6 15. I agree to send a deposit made out to the Parkinson s Disease Foundation ($200 for faculty/$150 for auditors) to: Parkinson's Disease Foundation / Attn: EJS-VNF Program at PDF / 1359 Broadway, Suite 1509 / New York, NY / In MEMO please write: "Deposit EJS-VNF" and the location of your training. The deposit will hold a space for you in the program. It is refundable upon completion of the didactic portion of the program. No refunds will be given if a cancellation is made less than 45 days of program date. Yes No No. I have been given permission to audit the course and waive the fee. Thank you for applying to The Edmond J. Safra Visiting Nurse Faculty Program at the Parkinson s Disease Foundation. We appreciate your interest in this program. We will review your application and contact you within two weeks of receipt of your application. If you have any questions regarding this process or overall course questions, please us at: nursing@pdf.org. This is a sample survey. Please apply online at Page 6
EJS-VNF 2018 Application
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