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* 1. Personal/Professional details:

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* 2. Please list papers published in the last 10 years in peer reviewed Journals as first author (references): List in APA format; if greater than 8 papers list most recent

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* 3. Please list books or book chapters authored/edited by you in the last 10 years (reference): ( List in APA format; if greater than 5 list most recent)

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* 4. List any national or professional awards received over your CNS professional career (List title/conferring organization):
 

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* 5. List participation in taskforce/committee in a professional or specialty organization writing clinical/evidence based practice or educational guidelines (List organization/taskforce/name of guideline/date):

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* 6. List leadership positions in professional nursing or specialty or healthcare organizations, board members of community/education or NFP organizations over your CNS professional career (List organization/title) :
 

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* 7. List any other professional practice achievements: (Leading change or EBP projects resulting in sustained outcomes such as  harm reduction, efficiency and/or cost savings):

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* 8. Number of

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* 9. What is the best part of being a CNS?

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* 10. How can your local NEOCNS organization be a valuable resource for you?

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