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1. Name (Required.)

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2. Credentials (Required.)

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3. Email Address (Required.)

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4. Mailing Address (Required.)

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5. Education - Highest Level and School (Required.)

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6. Employer and Current Position (Required.)

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7. I am a WNA Member and interested in serving in the following position. (Required.)

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8. What activities are you currently involved with or have been in the past related to WNA or ANA? (Required.)

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9. What other professional organizations are you involved with? (Required.)

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10. What other elected, appointed offices or community activities relevant to this position have you been involved with? (Required.)

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11. Please write a statement that indicates your view on issues facing WNA. Indicate why you want to serve in this role and why you are best qualified to carry out the duties of this office. This statement will be shared publicly with the membership. (Required.)

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12. Please include any other additional comments you would like to add. (Required.)

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13. Please type your name to agree with the below statement.
I have read the WNA Bylaws and duties for this office and if elected, I will serve WNA the interest of professional nursing and abide by the WNA Bylaws, Annual Meeting, Board policies and the ANA Code of Ethics for Nurses. If elected, 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. Upon elected, I will receive links to the following forms that must be completed prior to the first meeting. 1. Volunteer Participation Agreement 2. Conflict of Interest Policy. Completion of the line below serves as the electronic signature of the individal completing this form. (Required.)

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14. Date Submitted (Required.)

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