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* 1. Name

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* 2. Email Address

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* 3. Company

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* 4. Title

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* 5. Addres

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* 6. City

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* 7. State

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* 8. Zip

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* 9. Phone

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* 10. Number of Years Working in SCI:

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* 11. Are you previous the recipient of the Hammond Scholarship? Please note previous recipients of the Hammond Scholarship are ineligible for this scholarship.

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* 12. Please select one of the following.

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* 13. What excites you about spinal cord injury (SCI) nursing? (750 character maximum)

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* 14. How do you contribute as a member of the SCI multidisciplinary team to the patient's overall treatment plan? (750 character maximum)

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* 15. What do you see as your role in working with patients to reach positive clinical outcomes? (750 character maximum)

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* 16. How do you empower patients to be advocates for their care? (750 character maximum)

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