Credit Union of America - Nurse Grant Application

Applications are accepted until funds are depleted. Funds are added annually. Applicants must be CUA members in good standing working as a nurse. Not a member? Click here to join today!

Grants will be awarded or denied within 14 days of application submission. Courses must be job related and funds cannot be backdated for courses previously taken. Check will be made out to course provider. May only receive Nurse Grant once.

Nurse Grant Application

* - indicates required field

First Name

Last Name

Age

Birth Date (mm/dd/yyyy)

Registered License Title(s)

Daytime Phone Number

Evening Phone Number

Cell Phone Number

Primary Email

CUA Member #

Address

City

State

ZIP

How did you hear about the grant?

Amount Requested (up to $500)

Upcoming Class(es) Name, Date and Amount

Make Check Payable to (course provider name)

I’m a Nurse at

Department

Job Status

Full-TimePart-Time

Name of Supervisor

Phone Number of Supervisor

I certify all of the above information is correct

Applicant Signature

Date (mm/dd/yyyy)

By submitting this application, I authorize Credit Union of America to use my photograph, my name, and/or other information shared in an interview or on this application should I be awarded a grant. I also understand that if my combined award(s) is valued over $600 in one calendar year, I will receive a 1099 form from CUA for tax purposes, as my prize(s) will be reportable for IRS purposes. CUA does not publish or share publicly information such as account numbers, balances, phone numbers, addresses or other sensitive personal information.

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