Nominee Form

Step 1 of 3

Nomination

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

Advanced Practice Councillor

Practice 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 Public Directory 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)

To complement the existing strengths of the current CRNNL Board, candidates with any experience in any of the following would be considered an asset but are not necessary:
1) Information Technology, Privacy and Cyber-security: experience with the implementation, maintenance, and change of information technology and information management systems; experience with the implementation and management of privacy and cybersecurity policies and programs;
2) Equity, Diversity and Inclusion Leadership: experience with developing and promoting strategies to provide equitable access and opportunities, and correcting non-inclusive behaviour; and
3) Government and Public Relations: experience in lobbying, developing strategic communications, and stakeholder relations.

It would be helpful if you included any experience you have in either of these three identified areas in your biographical information on this form. Again, experience in any would be considered an asset but not necessary.

Nominator

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

Name(Required)

First Last

Email(Required)

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 2025-2028.

Member's Full Name(Required)

Date(Required)

Nominee Form

Nomination

Contact Information

Present Position

Nominator

Biographical Information

Nursing Education