Application Form

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Section 1: General Information

Section 2: Information About Your Mission

Release for Background Check

I am applying for a volunteer scholarship from One Nurse At A time whose mission is to promote volunteer nursing endeavors locally and internationally and to increase public awareness of humanitarian nursing.

I certify that all statements made in my application and associated documents are true, accurate and complete. I authorize One Nurse At A time and its officers to investigate in any manner they deem appropriate, at their sole discretion any educational, employment, volunteer or professional background, and any public or private records and to contact my personal references. I consent to and authorize One Nurse At A time to communicate with any and all of my previous and current employers as well a volunteer organizations with which I may previously or currently be involved.

In consideration of applying for a scholarship from One Nurse At A Time, I hereby release and forever discharge One Nurse At A Time, its officers, agents, and employees from any and all claims, demands, damages, or liability relating to or arising out of the requesting or furnishing of, any information relating to my records and references as described above.