Directions for CompletingThe National Asthma Educator FoundationLinda B. Ford, MD Scholarship Application

 

Applicants must be eligible to take the exam as per the NAECB guidelines (www.naecb.org). Preference is given to individuals who will improve the asthma care for individuals with asthma in underserved areas.

 

Individuals who qualify for the scholarship will be evaluated by the committee for eligibility. Scholarships of $200 will be granted biannually and the applicant will be responsible for the remaining $95 fee to take the exam. The scholarship must be used within six months of being granted or will be forfeited. Credentials will be verified prior to entering the selection.

 

The scholarship may not be used to retroactively cover any examination fees that have already been paid. This scholarship can only be used for payment for a future examination.

 

If you have previously submitted an application and did not receive an award, it is recommended that you resubmit an application for consideration
There will be two scholarships offered annually for certificants that wish to recertify by exam. The scholarship amount is for $150 and the applicant will be expected to pay the remaining $95.


#Expired certificants are not eligible at this time.


  • Name:*
  • Address*
  • City *
  • State *
  • Zip *
  • Phone No (Home) *
  • Phone No (Work):*
  • Email Address *
  • Lincensure (include type, state, number and date of cexpiration): *
  • Profession and current position with brief description of your responsibilities: *
  • Previous positions and responsibilities if less than 2 years: *
  • Amount of experience as an asthma educator (years and estimated hours per year): *
  • Employer's Name: *
  • Employer's Street Address: *
  • Employer's City: *
  • Employer's State: *
  • Employer's Zip: *
  • Have you taken the NAECB examination, previously: * Yes No
  • If YES, when?
  • Have you taken any review or preparatory classes for this examination, or do you intend to? If you have, provide name and date of courses taken: *
  • How does your employer support your efforts to become an asthma educator? *
  • Are you eligible for tuitional reimbursement? * Yes No
  • How did you learn about the scholarship?
     

Please briefly describe why you feel you should receive this scholarship. Include your past work with individuals with asthma, the age groups you work with, the settings in which you provide asthma education and what amount of your time is devoted to asthma education. Also include an explanation as to why you are requesting financial support to take the exam.

 

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