NAMSS Leadership Development Scholarship Application

NAMSS Leadership Development Scholarship

The NAMSS Leadership Development Scholarship was created in 2017 to include scholarship opportunities for MSPs to participate in the NAMSS Leadership Certificate Program.

Application Requirements:

Applicants must submit a completed application including:

A budget highlighting the expenses to be covered by scholarship
A personal statement of educational goals, objectives and a time-table for completion
A current CV/resume to include years of industry experience

Candidate Eligibility Requirements:

Applicants MUST be NAMSS members.
Applicants MUST be currently employed in the profession of medical staff or provider credentialing services or hold the NAMSS CPCS or CPMSM and currently seeking employment in same.
Individuals serving as Board members and/or instructors are NOT eligible to apply.

Deadlines:

June 28, 2019 and MUST be for funding needed between July 15, 2019 and January 21, 2020
December 31, 2019 and MUST be for funding needed between January 21, 2020 and July 15, 2020

NAMSS Leadership Development Scholarship Application

The NAMSS Leadership Development Scholarship Applications are accepted twice a year. Applicants will be notified of the Education Committee’s decision by July 15, 2019 and January 21, 2020. Please review the NAMSS Education Scholarship policy prior to completing your application.

Name*

First Name

Last Name

Credentials*

Please enter your credentials in the order you would like them to appear. e.g. CPCS, PhD would populate as Jane Doe, CPCS, PhD

Office Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Office Telephone Number*

Office Email*

Home Address

Address Line 1

Address Line 2

City

State

ZIP Code

Home Telephone Number

Home Email

I am a current member of the National Association Medical Staff Services*

Yes No

I am a current member of a State Association Medical Staff Services*

Yes No

If you checked yes to being in a State Association, please state which one below:

I have applied for a scholarship in previous years*

Yes No

Number of education programs attended in the last year:*

Scholarship Information:

I have included all additional requested materials as outlined in the procedures under Application Requirements above:*

Yes No

I am requesting the following amount:*

Please review the NAMSS Educational Scholarship policy for maximum amount for each type of scholarship.

I hereby request consideration of my application for the scholarship offered by the Education Committee of the National Association Medical Staff Services. I attest that the information submitted is true and accurate. I authorize NAMSS to verify my employment.*

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Use your mouse or finger to draw your signature above

Date:*

Upload Budget*

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Budget should highlight the expenses to be covered by scholarship

Upload Personal Statement of Educational Goals, Objectives and a Time-Table*

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Upload CV/resume*

No File Chosen

File uploads may not work on some mobile devices.

Current CV/resume to include years of industry experience