SIG Leadership Application

SELECT YOUR POSITION

Select which position you're applying for:

Choose your SIG / Position

You will be asked SIG/Position specific questions below.

CONTACT INFORMATION

First and Last Name

Credentials

Primary Email

Please include the best email for us to contact you regarding this inquiry.

Mailing Address 1

Mailing Address 2

City, State, Zip

Primary Phone Number

Please include the best phone number for us to contact you regarding this inquiry.

EMPLOYMENT

Job Title

Employer

AAACN & YOU

Certification - (Select all that apply)

Ambulatory

Telehealth

Care Coordination

Not Certified

Other (specify below)

Number of combined years you’ve been a AAACN member.

How many AAACN Annual Conferences have you attended in the last 5 years?

LEADERSHIP & EXPERIENCE

Please answer the following questions specific to the SIG you are applying to serve.

The VA SIG chair Elect position (only) requires the applicant to certify the following:

Minimum two years current employment in the VA

Current certification in Ambulatory Care Nursing or equivalent of two years/2000 hours in the Ambulatory Care setting

Describe your professional background regarding the topic of this SIG.

Describe your experience in the leadership or oversight of a group (professionally or as a volunteer).

What has been your participation in this SIG?

This role is a three-year commitment: one year will be served as Chair-Elect, one year as Chair, and one year as Past Chair. I understand this role is a 3-year commitment.

I can commit to attending AAACN’s Annual Conference in 2024 (where I will be the Chair/SIG session facilitator).

Do you have experience using your SIG’s Connected Community, or another AAACN Connected Community?

STATEMENT OF INTEREST

State why you are interested in serving as Chair-Elect of your SIG.

Please list any additional experience or comments you feel would make you an ideal candidate for the role of Chair-Elect of your SIG.

SIGNATURE & DATE

The information provided in this application is accurate and complete.

Your Digital Signature

Date

How did you hear about this opportunity?

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SIG Leadership Application