ACNA 2018/2019 Volunteer Survey

Volunteer for ACNA

Create your volunteer profile to share your interest in getting involved in the work of ACNA

Question Title

* 1. Candidate Information:

Name:

Address:

City:

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

Question Title

* 2. Highest Level of Nursing Education Completed:

Other (please specify)

Question Title

* 3. Other relevant experience (e.g. business skills, marketing, certification, degrees, etc.):

Question Title

* 4. Years of Practice:

0 - 2 Years (Including Students)

3 - 5 Years

6 - 10 Years

11 - 20 Years

21 - 35 Years

More than 36 Years

Question Title

* 5. Work Environment:

Acute Care

Long Term Care

Assisted Living

Education

Rehabilitation

Research

Pediatrics

Other (please specify)

Question Title

* 6. Years as ACNA Member:

0 - 1 Years

1 - 5 Years

6 - 10 Years

Question Title

* 7. Past Volunteer Experience with ACNA

Question Title

* 8. Past Volunteer Experience with Other Organizations:

Question Title

* 9. RN License Number:

Question Title

* 10. RN Registration State:

Question Title

* 11. RN License Expiration Date:

Question Title

* 12. Please select the committee(s) on which you would like to participate:

Conference Planning

Education and Research

Membership

Students Only Committee and Student Representative

Social Media

Communications

Ad Hoc Projects

Question Title

* 13. Include a brief summary of relevant experience (300 words or less)

Question Title

* 14. For individuals interested in the Education and Research Committee, please upload your resume:

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

Choose File