National Forum State Representative Subscriber Application Survey

The National Forum of State Nursing Workforce Centers currently includes 45+ State Representative Subscribers. State Representative Subscribers are the go-to expert organization for the state. Only one organization per state can hold this role.

The Annual cost is $700 per calendar year and new State Representative Subscribers require Board of Directors Approval. You do not have to be fully developed and funded to apply to become a state subscriber. For those state subscribers that join at different parts of the year- the annual fee is prorated.

Please complete the application below for consideration. Questions? email info@nursingworkforcecenters.org

1.State Organization Name

2.State Organization Website address

3.Contact Information

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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 Representative Subscriber per state. (submit documentation below).

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?

5.Please attach documentation for question 1 here.

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