2019 Nomination Application Form

PLEASE NOTE: CURRICULUM VITAE SHOULD BE NO MORE THAN 5 PAGES IN TOTAL.

1. Personal Information *This question is required.

First Name

Last Name

Credentials

Title / Position

Employing Agency / Institution

Street Address

Room / Floor / Suite

City

State

Zip

Country

Email Address

Work Phone

Home or Mobile Phone

URL

2. What types of Programs/Institutions are represented by your organization? *This question is required.

Please enter your individual NLN Member ID.^†
^†Click here to open the NLN member ID lookup page in a new browser window. *This question is required. This question requires a valid number format.

3. Gender *This question is required.

Male
Female

5. Please rank in order of preferenceSelect up to 3 positions Order the items from the following list. First select an item with the spacebar to show a menu of possible ranking positions. Next, click a ranking position to order it in the ranked list. Note the menu will display more ordering options as you add items to the ranked list.

President -elect
Secretary
Governor-at-Large
Certification Commission Commissioner
Nominations Committee Member

6. I would be willing to be contacted by the Nominations Committee for other NLN opportunities. *This question is required.

7. Do you speak a language other than English? If yes, which language(s):

8. Describe how your professional accomplishments are congruent with the mission, vision and core values of the NLN (250 words or less). *This question is required.

9. How have your professional accomplishments and experiences developed a skill set that prepares you for the potential NLN position(s) (250 words or less)? *This question is required.

10. What attributes and expertise and do you possess that demonstrates your ability for this position(250 words or less) ?

*This question is required.

11. What actions show your commitment to diversity and inclusive excellence within the professional environment (250 words or less)? *This question is required.

12. Please attach your current abbreviated curriculum vitae (CV), which is no more than 5 pages in length substantiating your primary area of contribution to nursing education and emphasizing your accomplishments; (e.g. involvement in professional organizations, including membership in NLN and service on NLN committees, panels and task groups, consultation provided, publications, presentations, honors, awards, etc.).

Include in your CV information on how you contributed to innovative teaching strategies, community and global engagement, inter-professional alliances, mentoring, under-served communities, financial or fiduciary responsibilities and public policy.

Applicants who submit CV's longer than 5 pages will not be considered for any position. *This question is required.

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13. The National League for Nursing (NLN) is a tax-emept, not-for-profit organization. In order to maintain tax exempt status, all interested persons must comply with guidelines and procedures of the NLN conflict of interest policy. In accordance with this policy, I acknowledge that I will disclose any and all actual, potential or perceived conflicts of interest with the NLN or its entities. I also acknowledge that I am responsible to update all disclosure information at such time that any changes occur. *This question is required.

Do you acknowledge the above statement and agree? *This question is required.

Do you have a conflict you wish to disclose? *This question is required.

At the present time, I believe I have no conflict of interest.
At the present time, I am disclosing the following potential, actual, or perceived conflict of interest.
Please explain Please enter an 'other' value for this selection.

Thank you for completing the Nominations Application & Bio-Sketch. The information you have submitted has been received as part of the nominations process at the National League for Nursing. All nomination information received is maintained as confidential and is used solely for the purposes of developing a slate of candidates for the annual ballot.

2019 Nomination Application Form

Personal and Member Indentification Information