WSTRA CTR Examination Scholarship Application

Please provide the following information. Please ensure that all sections of this form are completed or we will be unable to consider your application.

General Applicant Qualifications:

The applicant must be an active member of WSTRA for at least one (1) year in good standing.
The applicant must not have previously received WSTRA funds for the examination.

Qualifications to Sit for NCRA’s CTR Examination:

The applicant must meet the eligibility criteria for certification as defined by the National Cancer Registrars Association (NCRA), Council on Certification.
The amount of the scholarship will be equal to the Certification examination fee charged for a “current NCRA member.

Application and Award Process:

The applicant must mail the completed and signed application to the WSTRA Board. Current WSTRA membership will be verified.
The WSTRA Board will select a recipient and award a scholarship for the spring examination and one for the fall examination. Selection will be based on a brief written summary of the recipient’s experience, number of years as a WSTRA member and number of years employed or involved in the Cancer Registry.
Upon approval, the recipient will be reimbursed funds equal to the amount of what is charged for a current NCRA member Certification examination fee after having completed the NCRA CTR examination. Proof of exam completion is to be provided by the recipient.
The applicants not approved for funding will be notified in writing. The rationale for not approving the request will be included in the letter.

1. Demographic Information

First Name *This question is required

Last Name *This question is required

Title

Company Name

Street Address *This question is required

Apt/Suite/Office

City *This question is required

State *This question is required

Zip *This question is required

Email Address *This question is required

Home Phone Number

Business Phone Number

2. Please provide a brief summary of your experience in the cancer registry field. *This question is required

3. Length of time in cancer registry field *This question is required

4. Length of time as WSTRA Member *This question is required

5. Date of Exam *This question is required

calendar

6. Testing Center Site *This question is required

NOTE: Upon sitting for the CTR examination, the scholarship recipient must send a receipt for the application fee and proof of exam completion within thirty (30) days after the exam date.

By submitting this application:

I understand that scholarship funds will be used only to pay the CTR examination fee and that the scholarship is a one time award.
I agree to submit a copy of the receipt for the application fee and proof of exam completion within thirty (30) days after the examination date. The information contained in this application is strictly confidential and will not be communicated to any person other than those involved in the administration of the scholarship.