CNSW Local Chapter Affiliation

Council of Nephrology Social Workers
Local Chapter Affiliation

Welcome!

Review the Guidelines for NKF-CNSW Chapter Affiliation if this your first time affiliating or you need a refresher.

A red asterisk (*) indicates a required field. You will not be able to submit this application if a required field is blank.

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Chapter Name: *

Geographical Area Served: *

NKF Region Representative: *

Does the chapter collaborate with the local NKF office? *

Yes No

If so, please note NKF office name and primary contact:

Chairperson: *

Phone: *

Area Code Phone Number

Fax:

Area Code Phone Number

Email: *

This is the email that notifications will be sent to.

Membership profile:

MSW: *

Student: *

Total: *

Frequency of meetings:

Monthly Biannually Quarterly

Does chapter charge dues?

Yes No

Membership dues amount:

Elections are held in:

Term of office begins in:

Length of Term:

Other Officers

Chair-elect: *

Secretary: *

Treasurer: *

Other:

(Position, Name)

*Required: Membership Roster

Upload a copy of your chapter's membership roster, as a Microsoft Excel document.

Please name your document in the following format: "[ChapterName]Roster.xls".

*Roster should include the following:

First name
Last name
Appropriate credentials (MSW, LSW, LCSW, etc.)
Preferred mailing address
E-mail address
If known, please indicate if the local member is also an NKF-CNSW national member (not required).

Filenames CANNOT exceed 50 characters.

Roster: *

*Required: Chapter Rules & Regulations

All Local Chapters must abide by the National Chapter of Nephrology Social Workers Rules and Regulations.

The chapter may choose to have its own Rules and Regulations/Bylaws. If your chapter has established its own Bylaws, upload a copy here (Microsoft Word or PDF document).

We are using the National CNSW Rules and Regulations. (If 'Yes', no attachment needed.) *

Yes No

Otherwise, upload chapter bylaws here:

Please name your document in the following format: "[ChapterName]Rules.doc”

NKF Policies

By completing the 2011 Local Chapter Affiliation, the Chapter is also affirming it has read and accepted NKF's chapter policies.

*

I have read and understand the chapter policies

Statement of Support:

I agree to support the NKF Council of Nephrology Social Workers, to accept their Rules and Regulations, and to abide by the guidelines for affiliation.

*

I agree with the above statement

Your Name: *

First Name Last Name Cred

Thank you very much for your time, effort, and support!