Application - Research

Research Committee Application

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* 1. Your Contact Information:

Your Name

List Credentials

Address

City/State/Zip

Email

Preferred Phone

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* 2. How long have you been a member of ANNA?

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* 3. What is the expiration date of your ANNA membership?

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* 4. What is your current professional role?

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* 5. What is your area of focus/special interest in nephrology nursing?

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* 6. Have you ever served in another national committee or SPN role with ANNA? If yes, please list them here:

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* 7. Please indicate your answer below:

	Yes	No	Needs work
Do you generally have daily access to email?	Do you generally have daily access to email? Yes	Do you generally have daily access to email? No	Do you generally have daily access to email? Needs work
Do you have daily access to the internet?	Do you have daily access to the internet? Yes	Do you have daily access to the internet? No	Do you have daily access to the internet? Needs work
Can you download a file?	Can you download a file? Yes	Can you download a file? No	Can you download a file? Needs work

Please indicate any challenges you have with communicating via email:

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* 8. Can you participate in monthly conference calls on a weekday evening?

Yes

No

Comments

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* 9. Have you ever attended an ANNA National Symposium of Fall Meeting?

National Symposium

Fall Meeting

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* 10. Please rate your skill level in these areas:

	Excellent	Very good	Adequate	Needs work
General computer skills	General computer skills Excellent	General computer skills Very good	General computer skills Adequate	General computer skills Needs work
Email communication	Email communication Excellent	Email communication Very good	Email communication Adequate	Email communication Needs work
Saving/attaching files	Saving/attaching files Excellent	Saving/attaching files Very good	Saving/attaching files Adequate	Saving/attaching files Needs work
Organization skills	Organization skills Excellent	Organization skills Very good	Organization skills Adequate	Organization skills Needs work
Meeting deadlines	Meeting deadlines Excellent	Meeting deadlines Very good	Meeting deadlines Adequate	Meeting deadlines Needs work
Word	Word Excellent	Word Very good	Word Adequate	Word Needs work
Excel	Excel Excellent	Excel Very good	Excel Adequate	Excel Needs work
PowerPoint	PowerPoint Excellent	PowerPoint Very good	PowerPoint Adequate	PowerPoint Needs work
Download internet files	Download internet files Excellent	Download internet files Very good	Download internet files Adequate	Download internet files Needs work
Developing and implementing research studies	Developing and implementing research studies Excellent	Developing and implementing research studies Very good	Developing and implementing research studies Adequate	Developing and implementing research studies Needs work
Developing and implementing evidence-based practice projects	Developing and implementing evidence-based practice projects Excellent	Developing and implementing evidence-based practice projects Very good	Developing and implementing evidence-based practice projects Adequate	Developing and implementing evidence-based practice projects Needs work
Reviewing and scoring grant applications	Reviewing and scoring grant applications Excellent	Reviewing and scoring grant applications Very good	Reviewing and scoring grant applications Adequate	Reviewing and scoring grant applications Needs work

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* 11. How have you participated in planning and developing CNE?

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* 12. Why are you interested in serving on the Research Committee?

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* 13. According to the Role Description, are you qualified for this role?

Yes

No

Other (please specify)

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* 14. What is the greatest strength you would bring to the Committee?

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* 15. Is there anything else you would like to share with the Committee?