National Forum State Representative Subscriber Application The National Forum of State Nursing Workforce Centers currently includes 40 State Representative Subscribers. State Representative Subscribers are the go-to expert organization for the state. Only one organization per state can hold this role. State Representative Subscribers receive many benefits including: Name and link on Forum's location map Invitation to State Representative Subscriber quarterly online and in-person meetings Participate in National Forum as a voting member and run for Board of Director offices Serve as the point of contact for expert questions Access to multiple national networking opportunities through email lists, sharing sessions and committees Facebook and Linkedin Announcement Newsletter article in the quarterly Forum enewsletter Discount on Annual Conference Registration Email notices of Grant Funding opportunities The Annual cost is $700 per calendar year and new State Representative Subscribers require Board of Directors Approval. Please complete the application below for consideration. Questions? email info@nursingworkforcecenters.org Question Title * 1. State Organization Name Question Title * 2. State Organization Website address Question Title * 3. Contact Information Name Address Address 2 City/Town State/Province -- 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 Question Title * 4. Please briefly describe how your organization meets the required subscription criteria below. The subscriber is recognized as the state nursing workforce center. There shall be no more than one State Represntative Subscriber per state. Your organizations ability to contribute to the goals of the National Forum. Your organization focuses on statewide nursing workforce issues across the continuum of care. Your organization has nursing leadership. Your organization includes collaboration of a diverse group of stakeholders in nursing care, such as nursing education and the healthcare industry. Your organization has an active website and email contact. Is there anything else you would like to indicate with your application? Done