Council Nomination Form (Nominee)

Part 1: Nomination

I am offering myself as a nominee for the following position(Required)

Central Region Councillor

Labrador-Grenfell Regional Councillor

Education/Research Councillor

Administration Councillor

Name(Required)

First Last

Maiden Name (if applicable)

CRNNL Registration Number(Required)

If you do not know your CRNNL Registration Number, please use the Member Search to find it.

Contact Information

Address(Required)

Street Address Address Line 2 City Province Postal Code

Phone (Work)(Required)

Phone (Home)(Required)

Email(Required)

By providing your e-mail address, you will receive a confirmation message when the form is submitted.

Present Position

Please identify your employer, position, area of practice and employment dates for your current employment.

Employer(Required)

Position(Required)

Area of Practice(Required)

I have been in this position since(Required)

(Dates)

Nominator

Please provide the following information about the member who has agreed to be your nominator.

Name(Required)

First Last

Email(Required)

Declaration - Part I

By submitting this form, I declare the following to be true(Required)

I am a current practicing member of CRNNL in good standing.

I consent to run for the position I have selected above.

If elected, I agree to(Required)

serve a three-year term from 2024-2027.

Member's Full Name(Required)

Date(Required)

Part II: Biographical Information

Nursing Education

Please identify your initial (basic) nursing education (graduation school and date) and any post-graduate education that you have completed.

Graduate of(Required)

(school of nursing)

Graduation Year(Required)

Professional Development/Continuing Education

Please specify any nursing courses/degrees/certifications completed since graduation and the year completed. Please spell out any acronyms.

Professional Activities

Please list any provincial or national nursing or health committees, boards, working groups and chapters or special interest groups in which you have participated. Provide dates and identify your position if applicable (e.g., member, chair, president, etc.).

Personal Statement

Please provide a brief statement of why you wish to run for Council (maximum 1000 characters).

Declaration: Part II

Member Full Name(Required)

Date(Required)

By submitting this nominee form you are confirming that you have read the related Council Policies (GP-1: Role of Council, GP-2: Code of Conduct, and GP-3: Conflict of Interest as well as the CRNNL By-Laws 2023 related to the Nominations & Elections Process – Article VII & Article VIII) and you agree to be in compliance with same.

Name

This field is for validation purposes and should be left unchanged.