Ann Wolfe Scholarship Nomination Application

The 2024 scholarships will cover the entire NC/SC Annual Perinatal Conference registration, a one-year NCPA membership, and $250 to be applied to conference travel expenses. Two scholarships are offered as a reward and recognition for staff employed by local health departments in maternal and child health programs. Nominees should have demonstrated commitment to improving the health and welfare of women and infants in North Carolina. Membership in NCPA is strongly encouraged. Nominees must be currently employed by a local health department with a minimum of 3 years’ experience in women’s and/or children’s health. Please provide examples of excellence to support your nomination.

The Ann Wolfe scholarship fund was established in memory of former board member Dr. Ann Wolfe and was made possible through a gift from the estate of Dr. Wolfe.

Ann Wolfe Scholarship Nomination Application

Name and Title of Nominee:(Required)

Nominee’s Home Address:

Nominee’s Email Address:(Required)

Nominee’s Phone Number Including Area Code:

Agency Name Where Nominee is Employed:

Agency Mailing Address:

Nominee’s Discipline:

# Years Nominee has worked in Local Health Dept:

# Years Nominee has worked in Women’s or Children’s Health

Name and Title of Person Submitting Nomination:

Nominator’s Mailing Address:

Nominator’s Phone Number Including Area Code:

Nominator’s Email Address:

Reasons for Nomination: