Review your answers carefully! We will use your info as you write it. URLThis field is for validation purposes and should be left unchanged.IMPORTANT INSTRUCTIONS. Thank you for stepping up for a leadership position. You are needed, and we are excited to get going! Before you start, you must understand that the information we include on the ballot—your credentials, employment, dates, degrees, schools, membership, narrative—will be published as received. To ensure fairness and neutrality, we do not proofread or edit for clarity, spelling, grammar, content, or even typos. In this way, you and your voting colleagues know that each submission is editorially identical and unbiased. It is acceptable to have someone review your submission, or even to ask AI, but the authenticity of your work and your voice must be preserved, not altered.Consent* I have read and understand the instructions. My submission will be my authentic work and voice.CONFLICT OF INTEREST DISCLOSURE. A conflict of interest may exist when your personal, professional, financial, or organizational interests could influence, or appear to influence, your ability to act in the best interests of the Pennsylvania State Nurses Association (PSNA) and/or the Nursing Foundation of Pennsylvania (NFP). Conflicts may involve you, a family member, business associate, employer, client, or another organization with which you are affiliated. Examples may include (1) financial interests in organizations that do business with PSNA/NFP; (2) employment, consulting, or board or committee or leadership service with organizations whose interests may overlap or conflict with PSNA/NFP; (3) receipt of gifts, favors, or other benefits from individuals or organizations doing business with PSNA/NFP; (4) access to confidential information that could benefit you or another organization; and/or (5) situations where your duties to another organization may conflict with your responsibilities to PSNA/NFP. Potential conflicts of interest do not automatically disqualify a candidate from serving. Disclosed conflicts will be reviewed to determine whether they can be appropriately managed, mitigated, or eliminated.DO YOU HAVE ANY ACTUAL OR POTENTIAL CONFLICTS OF INTEREST TO DISCLOSE? If yes or unsure, we will contact you to discuss. No. I do not have a conflict of interest. Yes. I do have a conflict of interest. Contact me to discuss. I am unsure if I have a conflict of interest. Contact me to discuss. PSNA position for which you would like to be a candidate.*Select PositionPSNA Board President (1 position open)PSNA Board Treasurer (1 position open)PSNA Board Member (1 position open)PSNA Board Member New to Practice (1 position open)PSNA Nominating Committee (2 positions open)PSNA Nursing Cabinet (3 positions open)Are you the incumbent for the position you just selected--i.e., do you currently hold that position?* Yes No List your full name to appear on the ballot. Do not add your credentials or title here.*List your credentials as they should appear following your name.*Your pronouns. Will be on the ballot unless you check "No pronoun."* She/Her/Hers He/Him/His They/Them/Theirs No Preference No Pronoun Preferred phone number. This will not be on the ballot, but we need to be able to reach you.*Your preferred email for us to reach you. Not on ballot.* Name of your current employer or employing organization*Title of your current position*Length of time with your current employer*Education. Be precise. Start with highest degree. For each, include name of degree, area of study, year or degree, name of school.*Previous employment. List and briefly describe the two most recent positions you held prior to your current one. These can include different positions with the same employer. If you are new to practice and do not have two prior positions, say so.*In addition to your being a member of PSNA and the American Nurses Association (ANA), list any other role(s) or position(s) you hold or have held with PSNA/ANA. In no more than a sentence or two, say what you do or did for each. If no PSNA/ANA position other than membership, say so.*List your current membership(s) in any professional organization(s) or association(s) OTHER THAN membership in PSNA/ANA. If you act or have acted in a leadership role with the other organization(s) or association(s), describe/explain briefly in a sentence or two. If no such membership and/or leadership activity, say so.*How can you and will you help PSNA meet its mission to improve the lives and careers of nurses in Pennsylvania through legislative advocacy, professional development, and connection? NOTE: If you are a candidate for the new-to-practice board member position, speak to that. Limit 1,300 characters, including spaces, or approximately 200-250 words.*Explain to your voting colleagues why they should elect you. Why are you the right candidate? For example, is it your experience? A new perspective? Career accomplishments? Passion and enthusiasm? Personality? Connections? Something else? Do not let these examples constrain you. NOTE: If you are a candidate for the new-to-practice board member position, speak to that. Limit 1,300 characters, including spaces, or approx 200-250 words.*Upload your CV or resume. Be sure it is current. It is for our files and will not be on the ballot.* Drop files here or Select files Max. file size: 5 MB. Upload a CURRENT picture, head and shoulders shot, for the ballot. It does not need to be a professional photo, but it should be clear and in focus. It should not include other people or props or verbiage.* Drop files here or Select files Max. file size: 5 MB.
