For Licensed Practical Nurses wanting to run in the upcoming election for District Council Member, please complete this nomination form. 

We strongly recommend reading the entire form before filling it out.
Time Commitment:
Serving on Council requires a significant amount of time to prepare for and attend meetings, committee work, preparation, ownership linkage, board education, and initial orientation. The time commitment expected from a Council member is as follows: ½ day initial orientation, one-two days governance education, ½ day prep work for each meeting, one-two day quarterly meetings to review reports of College business and plan upcoming goals, one day annually as host of the Annual General Meeting and Education Forum, and one day as host for the annual Think Tank for a total of 12 days attendance per year plus other meetings as needed. Travel expenses and honorarium for meeting attendance is supported.

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* 1. Are you able and prepared to commit to the time as stated above?

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* 2. A computer is provided to Council members to facilitate their work. Are you reasonably proficient with email and downloading documents?

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* 3. Do you understand the nature of the position of Council Representative and consent to having your name included on the election ballot for the following District?

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* 4. Nominee Information

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* 5. What are the top three reasons that you would like to join Council that support and align with CLPNA's Mandate, “To lead and regulate the profession in a manner that protects and serves the public through excellence in practical nursing.”? Please click on the following link for more information:

Read Council Vision, Mission & Mandate

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* 6. What would you identify as your top three competency strengths (knowledge, experience or attributes) that you would bring as a Council Member? Please click on the following link for a list of Council Competencies:

Read Council Member Competencies

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* 7. Educational Background (nursing and other) (Please provide the name of program, such as 'Practical Nurse' or 'Bachelors of _____'; name of the Educational Institution; and the year you completed the program / graduation year.)

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* 8. Employment Background (Please provide your nursing-related employment, starting with your present employer and position, such as 'XYZ Hospital, Staff Nurse, 2015 - 2020')

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* 9. Professional Groups (Please list any professional groups you may have been involved with including involvement with CLPNA or board positions as it would relate to the Council position.)

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* 10. Community Activities (Please list any community activities you are involved in (i.e. Red Cross, Volunteer, 2012-2013) as it would relate to the Council position.)

Please provide the following information for three (3) Licensed Practical Nurses who support your nomination

All Nominators will be contacted for verification of nomination.

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* 11. Nominator # 1 Information

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* 12. Nominator # 2 Information

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* 13. Nominator # 3 Information

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* 14. Please upload a good quality, head and shoulders picture of yourself
(passport-type portrait)

PDF, DOC, DOCX, PNG, JPG, JPEG file types only.
Choose File
Once you have completed the nomination form, Executive Assistant Marge Malenfant will provide instructions on how to complete a one (1) minute video, where you will have the opportunity to let LPN voters know why you are the best candidate seeking election to Council in your district.

Please Note – The candidate profile and photo along with the video will be used in the election information distributed to all members in the Election District.

Thank you and good luck on the election in your District!

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