2011-2012 ONSA Board of Director Application To Run For Office

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1. Please complete the following contanct information below:

Please complete the following contanct information below:   Name:
College of Nursing
Address:
Address 2:
City/Town:
State:	-- select state --AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming
ZIP/Postal Code:
Email Address:
Phone Number:

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2. I certify that I am all of the following:

I certify that I am all of the following:   I am currently enrolled in a state approved nursing program A student in good standing with my stated College of Nursing Program Active Member of ONSA

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3. I am submitting my name to run for the following Office on the 2011-2012 ONSA State Board

I am submitting my name to run for the following Office on the 2011-2012 ONSA State Board   President (needs 1 year of experience on board) 1st VP 2nd VP Treasurer Secretary Newsletter Editor Community Projects Director Break-Through to Nursing Director Membership Director Director at Large

Other (please specify)