VIETNAMESE-AMERICAN NURSES' ASSOCIATION (VANA)

Why Become A Member?

Benefits
  Exchanging ideas with other nurses and healthcare professionals
  Developing professionally through networking, leading, learning, teaching, practicing, and researching 
  Attending all VANA events at no cost or reduced fee
  Making positive differences in others' lives
 Applying for VANA Nursing Student Scholarship



Annual Membership Fee

$45 for nurses and other healthcare professionals
$10 for nursing students
Donations are always welcome
How to Become A Member
To become a member please complete the following application and send it with a check or money order to:
VANA
PO BOX 691994
HOUSTON, TX, 77269-1994
 
 VIETNAMESE-AMERICAN NURSES ASSOCIATION
Membership Application Form
 
Submission is for (check one):  ☐ New Member Application      ☐ Member Renewal     ☐ Update Profile
 
Type of Membership (check one)
☐ Nurses $45                                                                   ☐ Students $10 (need proof of enrollment in nursing program)
☐ Associate -other Healthcare Professionals $45
 
                                                                                                                                                                                                                               
Name: Last                                                                        First                                                                       Middle
 
                                                                                                                                                                                                                               
Home Address                                                                                  City                                        State                     Zip
 
                                                                                                                                                                                                                               
Home Phone                                     Cell Phone                                          Email
 
                                                                                                                                                                                                                               
Employer                                                                                                            Title
 
                                                                                                                                                                                                                               
Work Address                                                                                   City                                        State                     Zip
 
Age:  ☐ < 21      ☐ 21-30               ☐ 31-40               ☐ 41-50               ☐51-60                ☐61-70                ☐ > 70
 
Gender:  ☐ Female        ☐ Male
 
Marital Status:  ☐ Single             ☐ Married         ☐ Divorced        ☐ Widowed      ☐ Separated
 
Ethnicity:  ☐ Asian American     ☐ African American       ☐ Native American        ☐ Hispanic         ☐ Caucasian     
 (If Asian, select one)
☐ Chinese         ☐ Pacific Islander            ☐ Japanese       ☐ Vietnamese ☐ Korean           ☐ Other:                           
 
Are you interested in serving as an officer and/or a committee member?
Committees: ☐ No         ☐ Yes (f yes, check one of the following)
☐ Awards/Scholarship                 ☐ Bylaws                            ☐ Development              ☐ Education     
☐ Finance                                          ☐ Membership                               ☐ Policy
Officer:  ☐ No                  ☐ Yes (f yes, check one of the following)
☐ President                                      ☐ Vice President            ☐ Director of Finance                  
☐ Communication                          ☐ Membership               ☐ Education
 
Please sign and return this form with your dues                                               Annual Membership Dues: $                     
 
Signature:                                                                                                                           Fund Contribution: (optional) $                               
 
Date:                                                                                                                                     Total Enclosed:                                       $                       
 
VANA MEMBER PROFILE
 
I am a (n)      ☐ RN           ☐ LVN/LPN       ☐ RN Student (Graduation year/degree:             /              )          ☐ Other
 
Highest Degree Earned:  ☐ Baccalaureate           ☐ Associate      ☐ Diploma         ☐ Voc-Tech
☐ Doctorate (Specify):                                                                                                 ☐ Master s (Specify):                                                   
 
National/State Certification:  ☐ No       ☐ Yes (if yes, please specify):                                                                                  
 
Area (s) of Practice (circle no more than two)
☐ Administration            ☐ Child Health                                 ☐ Gerontology                                ☐ Mental Health
☐ Adolescent                   ☐ Community Health                    ☐ Informatics                   ☐ Midwifery    
☐ Adult Health                ☐ Education                                      ☐ Managed Care            ☐ Research      
☐ Anesthesia                   ☐ Family Health                              ☐ Maternal Health         ☐ Women’s Health       
☐ Other:                                                                                           
                               
Career Experience:  ☐ < 1 year                                 ☐ 1-5 years       ☐ 6-10 years     ☐ 11-15 years          ☐ Over 15 years
 
Employment Status: ☐ Full-time             ☐ Part-time      ☐ Unemployed               ☐ Retired           ☐ Student
 
Specialty area (s)(select no more than two)
☐ AIDS/HIV                       ☐ Community Health                    ☐ Research
☐ Critical Care                  ☐ Education                                      ☐ Women’s Health
☐ Diabetes                        ☐ Family Health                              ☐ Medical (specify):                                                                     
☐ Emergency Room      ☐ Neonatal                                       ☐ Surgical (specify):                                                                     
☐ Child Health                 ☐ Oncology                                       ☐ Other (specify):                                                                         
 
Work Place
☐ Acute Care Hospital                  ☐ Community Health                    ☐ Military                          ☐ Public Health
☐ Ambulatory/Clinic                     ☐ Education                                      ☐ Nursing Home             ☐ Self-employed
☐ Association/Foundation         ☐ Family Health                              ☐ Occupational               ☐ Voc-Tech
☐ College/University                    ☐ Government Agency               ☐ Private Industry        
☐ Other:                                                                                                           
                                               
Type of Position
☐ Clinical Specialist        ☐ Faculty-Academic      ☐ Nurse practitioner                     ☐ Self-employed
☐ Consultant                    ☐ Head Nurse                  ☐ Recruiter                                       ☐ Staff-nurse
☐ Dean                               ☐ Nurse executive        ☐ Researcher                                   ☐ Supervisor/Coordinator
☐ Educator-clinical         ☐ Nurse manager          ☐ Sales Representative                              
☐ Other:                                                                                                           
 
  

How to Apply for Scholarship
To apply for scholarship please complete the following application and send it to
VANA 
PO BOX 691994
HOUSTON, TX, 77269-1994

Vietnamese-American Nurses' Association Nursing Scholarship
  
Purpose: To provide scholarship to nursing students who demonstrate academic excellent and financial needs.

Awards: A scholarship of $500.00 will be awarded one time to a recipient.

Qualifications:

  1. The candidate must be currently enrolled in a nursing program of the academic year.
  2. At the end of each year of scholarship participation, the recipient shall submit a summary describing the education activities in which he/ she participated.
  3. The candidate must be member of VANA, attending 3 VANA meetings per year, and participating in VANA health fair.
  4. The candidate has current GPA at least 3.0 or above and can demonstrate financial needs. The candidate will need to obtain GPA or grade report from school and attach it to the application along with any document which can support the financial needs.

Requirements:

  1. Application must be typed and submitted prior to the deadline.
  2. Application deadline is on May 1st for Fall Semester and November 1st for Spring Semester.
 
Application packet

  1. Application
  2. Copy of transcript of current nursing program
  3. One letter of recommendation
  4. A $5.00 application fee made payable to the VANA

Deadline date

Application packet must be received by the VANA, regardless of postmark or other circumstances by May 1st for the Fall semester and November 1st for the Spring semester.

If you have any questions, please contact the VANA at the following address:
                                Vietnamese American Nurse Association
                                PO Box 691994
                             Houston TX 77269-1994




Application form
I.General information
Full name: ____________________________________________________________________________
Address:______________________________________________________________________________
Home phone:    ________________________________           Cell phone:______________________________
E mail address:_________________________________________________________________________
Optional:
___African American
___Asian American/Pacific Islander
___Hispanic/Latino
___Native American
___Other (Specify)
Nursing school:________________________________________________________________________
Year: Junior________________________________  Senior:____________________________________
Projected graduation date: ______________________________________________________________
What degree in nursing will you receive: ADN________ __  BSN ___________ MSN______________
Cumulative Grade Point Average:__________________________________________________________

II. Future Goals: In the space provided, list your professional goals












III. Financial Needs statement: In the space below, please describe your financial needs













IV. Volunteer Community Activities related to health and nursing

Dates of Participation                                     Organization                                      Description of Participation





V. Membership in professional organizations: (nursing and non-nursing organizations)
Date of membership                                        Organization                                            Office Help/committee





VI. Education background
Institution                           Year of attended                            Degree/Diploma




VII. Honors/ Awards: