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ISAPN BOARD OF DIRECTORS CONSENT TO SERVE

MEMBER INFORMATION

1.PLEASE COMPLETE THE INFORMATION BELOW(Required.)
2.Which of the following most accurately describe(s) you?
(Required.)
3.Race/Ethnicity (Select all that apply)(Required.)
4.What are your pronouns? This helps us understand the best way to address you(Required.)
5.EDUCATION - highest level of education(Required.)
6.PLEASE INDICATE YOUR APRN SPECIALTY(Required.)
7.PLEASE INDICATE YOUR CLINICAL SPECIALTY i.e. primary care, acute care, women's health, etc(Required.)
8.EMPLOYMENT (Required.)
Candidates may only consent to be considered for one position.
9.I CONSENT TO SERVE IN THE FOLLOWING POSITION:(Required.)
10.PLEASE PROVIDE A CANDIDATE'S STATEMENT.  This statement will inform the members regarding your goals for the position and as a member of the ISAPN Board of Directors.(Required.)
Although the pronunciation of many names is obvious, some require special attention. If your name is one that
is pronounced in a special way, please use the key below to advise us how your name should be pronounced.

Indicate either the phonetic spelling of your name OR a familiar word that rhymes with your name.

Phonetic Spelling Instructions
11.Phonetic spelling of your name.
12.Please upload your headshot. 
No file chosen
13.If elected to the ISAPN board of directors, it is my obligation to attend meetings and do the work of the position.

If I am unable to fulfill this commitment, I will resign.

I elected, I will receive links to the following forms that must be completed prior to the first committee meeting.
1. Board Commitment Form
2. Code of Ethics
3. Conflict of Interest
4. Volunteer Participation Agreement
5. Board of Directors Confidentiality Agreement

Completion of the line below serves as the electronic signature of the individual completing this form.(Required.)