The Kelly Family Nursing Support Awards

stregthening professional and personal well-being

The Kelly Family Nursing Support Awards

The Kelly Family Nursing Support Awards provide financial assistance to nurses, who are the heart and soul of each hospital within Hartford HealthCare, and who may be experiencing financial hardship. This fund was created to support the professional and personal well-being of nurses who have demonstrated a commitment to exacting standards of care while facing financial challenges. It is is intended to assist nurses as they advance through various stages of their careers, including certification, education, and experiential learning.

The form below is for only for nurses requesting assistance through the Kelly Family Nursing Support Awards Fund. Please complete the following application to be considered for the award. All information will be kept confidential and will only be used to evaluate your eligibility for assistance.

Personal Information

Name(Required)

First Last

Hartford HealthCare Employee ID Number(Required)

Job Title/Description(Required)

Department/Unit(Required)

Phone(Required)

Email(Required)

Years of Service at Hartford HealthCare(Required)

Financial Hardship Information

Please provide a detailed explanation of the financial hardship you are experiencing (e.g. medical emergency, family support needs, housing issues, etc.)(Required)

Total amount of financial assistance requested (please provide a specific dollar amount)(Required)

How would assistance impact your ability to continue in your nursing role and support your professional responsibilities? Please explain how receiving the award will benefit your work and personal lives.(Required)

Have you received any other financial support or assistance within the past year?(Required)

If yes, please describe the support received.

Professional Commitment and Contributions

Why do you believe you deserve this award? Please share your contributions to Hartford HealthCare and your commitment to patient care. Please provide examples of how you have demonstrated commitment to excellence in your nursing role.(Required)

How has your experience as a nurse shaped your approach to patient care? Please describe your professional experiences and values.(Required)

References

Please provide at least one reference from a supervisor, colleague, or another healthcare professional who can speak to your commitment, work ethic, and character.

First Reference (required)

First Reference's Full Name:(Required)

First Reference's Relationship to Applicant(Required)

First Reference's Phone Number(Required)

First Reference's Email Address(Required)

Second Reference (optional)

Second Reference's Full Name

Second Reference's Relationship to Applicant

Second Reference's Phone Number

Second Reference's Email Address

Supporting Documents (optional)

You have the option to include any supporting documents using the file upload forms provided below.

File

Max. file size: 2 MB.

File

Max. file size: 2 MB.

Consent and Signature

By submitting this application, I acknowledge that all the information provided is accurate to the best of my knowledge. I understand that my application will be reviewed by a selection committee, and I consent to any necessary follow-up regarding my application. I authorize Hartford HealthCare to verify any information provided.

Consent by Inputting Your Full Name Here(Required)

Today's Date(Required)

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