“Achieving our Vision in 2020”
NOBC Additional Board Seats Registration Reporting Tool

Thank you for volunteering to help NOBC fulfill our key strategy of 10,000 board seats filled by nurses in 2020! This form was created to make registration outside of our database an easy process, to serve as a complement to our standard registration process. Please follow the directions below and reach out to us for any assistance. Thank you!

Context: NOBC has created a new reporting tool to provide a way for you to report specific board seats that are known to you, held by nurses that for a number of reasons, have not registered and are not likely to do so. In order to count these additional boards seats, we invite you to report them directly to us. Unless you indicate the individual wishes to opt in for communications, we will not contact them for any reason, to abide by our privacy policy and ensure data integrity.

Please note: NOBC will integrate the information into our the database, however, individuals will not be contacted by NOBC for any reason.

Please let us know if you have any questions. Thank you for taking the time to complete the form. Please return your completed form to nobc@nursesonboardscoalition.org and we will add them to our database to be counted!

Question Title

1. Salutation

Other (please specify)

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2. First Name (Required.)

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3. Last Name (Required.)

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4. Email (Required.)

Please note: Nurses on Boards Coalition will not contact you.

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5. Name of Organization where you are currently serving on a board (Required.)

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6. Current U.S. state of organization where you currently serve on a board (Required.)

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7. Is this a Nursing Association Board, Governor Appointed Board of Nursing, or Nursing School Board? (Required.)

Yes

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8. Current U.S. State of your home address (Required.)

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9. Are you interested in serving on another board? (Required.)

Yes

Not applicable- I am filling this form out for someone else

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10. Are you filling out this form for another person? (Required.)

Yes

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11. If you are filling out this form for another person, please write in your name. If you are filling this form out for yourself, please type N/A (not applicable). (Required.)

Please click "DONE" to submit the form. Thank you!

“Achieving our Vision in 2020” NOBC Additional Board Seats Registration Reporting Tool

Question Title

* 1. Salutation

Question Title

* 2. First Name (Required.)

Question Title

* 3. Last Name (Required.)

Question Title

* 4. Email (Required.)

Question Title

* 5. Name of Organization where you are currently serving on a board (Required.)

Question Title

* 6. Current U.S. state of organization where you currently serve on a board (Required.)

Question Title

* 7. Is this a Nursing Association Board, Governor Appointed Board of Nursing, or Nursing School Board? (Required.)

Question Title

* 8. Current U.S. State of your home address (Required.)

Question Title

* 9. Are you interested in serving on another board? (Required.)

Question Title

* 10. Are you filling out this form for another person? (Required.)

Question Title

* 11. If you are filling out this form for another person, please write in your name. If you are filling this form out for yourself, please type N/A (not applicable). (Required.)

“Achieving our Vision in 2020”
NOBC Additional Board Seats Registration Reporting Tool

1. Salutation

2. First Name (Required.)

3. Last Name (Required.)

4. Email (Required.)

5. Name of Organization where you are currently serving on a board (Required.)

6. Current U.S. state of organization where you currently serve on a board (Required.)

7. Is this a Nursing Association Board, Governor Appointed Board of Nursing, or Nursing School Board? (Required.)

8. Current U.S. State of your home address (Required.)

9. Are you interested in serving on another board? (Required.)

10. Are you filling out this form for another person? (Required.)

11. If you are filling out this form for another person, please write in your name. If you are filling this form out for yourself, please type N/A (not applicable). (Required.)