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About

Dr. Karlene Kerfoot Nursing Leadership in Technology Education Grant

Sponsored by: AONL, symplr and The DAISY Foundation

The Dr. Karlene Kerfoot Education Grant recognizes and supports nurse leaders who are passionate about leading innovation and technology in healthcare. Two Education Grants of up to US$5,000 each will be awarded to nurse leaders who demonstrate a strong background in

successfully implementing technology or innovation strategies and who articulate a clear vision for the future impact of their work on patient care.

Approved uses of funds include:

Attendance at national clinical informatics and/or technology-related conferences.
Obtaining specialized technology/clinical informatics certifications.

- Certification “bootcamps”

- Technology/informatics-related certification prep courses

- Certification courses (may be post-graduate)

- Exam costs
Pursuing graduate education in technology/clinical informatics.

- Contribution to tuition

- Books

- Scholarly project-related expenses (e.g. statistician)

Click here for eligibility requirements, selection criteria, and more information.

About You

First Name

Last Name

Credentials

Title

Phone

AONL Membership Number (to find yours, log in to AONL.org. Under Membership, you’ll find Manage My Account on the dropdown menu. From there, go to Account Profile. Your number is at the top of the page.)

Your Address and Contact Information

Street Address

Apt/Unit Number

City

State

Zip / Postal Code

Country

Current Employer Information

Current Employer:

City

State

Country

Educational Background

Highest Degree Obtained?

Current Educational Enrollment (if applicable):

Institution

Program

Expected Graduation Date

Application Details

Experience: Your background and achievements in implementing successful technology or innovation strategies within healthcare. (maximum 250 words):

Your Current Role or Project: Please provide a brief description of your current role or project focused on healthcare technology or innovation (maximum 200 words)

Planned Use of Grant Funds: How will you use your granted funds to advance your education/expertise in the application of technology to patient care?

Choose how you will use funds (pick one):

National clinical informatics and/or technology-related conferenceSpecialized technology/clinical informatics certificationGraduate education in technology/clinical informatics

Conference Information

Name of conference

Start date of conference

End date of conference

Location

Total Cost (Please use format X,XXX.XX)

What will be funded (e.g. registration, travel)

Certification Information

Name of certifying organization

Anticipated date of completion

Credential that will be received

Total Cost (Please us format X,XXX.XX)

Graduate Education Information

Name of institution

City

State

Anticipated graduation date

Degree that will be conferred

Total Cost (Please us format X,XXX.XX)

Outcomes

What educational goals do you hope to achieve through the education/certification you described above? (250 words)

Describe how your specific use of funds described above will help you use technology to advance patient care in the future (250 words)

Proposed Budget

Only your direct costs are reimbursable. Salary and vacation time are not reimbursable.
Alcoholic beverages are not reimbursable.

Examples of what the grant will cover are on the required spreadsheet below.

Please click here to download our spreadsheet (it is automatic so check your downloads folder), fill in your proposed expenses, and upload the completed document below.

Proposed Budget

When you you are ready to submit for reimbursement, you must provide adequate documentation supporting the expenses and their purpose, and clearly highlight those items on the receipt.

Uploads

Verification of enrollment or acceptance in a graduate program (if applicable)

Letter of Endorsement
Please upload a letter of endorsement from your organizations Chief Nursing Officer/Chief Nursing Executive or other Senior Administration and it needs to include verification of current involvement in a leadership role in healthcare technology or work on a technology project to advance patient care.

Letter of Endorsement

Letter of Agreement
Please copy and paste this onto your institution’s letterhead. Fill in the blanks, print it out and sign it. Your Chief Nursing Officer or other Senior Administrator's signature is also required as an indication of her/his support of your work. Then scan it into your computer or take a picture of it, and upload with this application. Your application is not complete without this document.

Letter of Agreement:

I, __________________________________________, _________________________________________________, commit the following if I am selected as a recipient of the Karlene Kerfoot Educational Grant:

Funds will be used only for expenses detailed in my chosen educational activity.
I will submit a report on my progress within xx weeks of the completion of my funded education.
I will provide receipts/verification of use of funds to The DAISY Foundation for reimbursement.
I will share my experience and success stories, providing inspiration and practical insights to peers at an AONL event.
AONL, symplr, and The DAISY Foundation are permitted to use my name and institution in their marketing materials to help promote the grant program.
I will credit funding from the Karlene Kerfoot Educational Grant co-sponsored by AONL, symplr and The DAISY Foundation upon publication/presentation related to education received from this grant.
AONL, symplr, and The DAISY Foundation may not be held liable for any risk in the implementation of this grant.
Signed ________________________________________ Date____________________

Acknowledgement
By checking this box and submitting the online form, you agree to The DAISY Foundation collecting and storing your personal contact information. We may contact you if we have questions about your submission or to discuss next steps. To learn more, please read our Privacy Policy.

I Agree

Letter of Agreement

Thank you for your application. Should you have any questions, please contact FaithThomas@daisyfoundation.org

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