National Office Request to Run for 2021-22 Board and NEC

Request for Application and Information

to run for 2021-22 Board of Directors and Nominating and Elections Committee
Please complete this form to request a packet of information on running for the NSNA Board of Directors and the Nominating and Elections Committee. (Red Stars indicate required fields)

Pre - Slate Deadline is January 20, 2021, 5 pm ET
Choose one *

Mr. Ms.
Full Name *

First Name Middle (optional) Last Name
Address *
City *
State *
Zip *
Cell Phone *
(or Primary Phone)
Home Phone
(Optional)
Email *

Confirmation Email Click here then click "Sub Label" above to change this text
NSNA Membership Number *
Expiration Date *

Month Day Year
School Attending *
Include School Name, City and State
Type of Program

Associate Diploma Baccalaureate RN to BSN Other
Office of Interest
Optional. You can decide later.
Expected Graduation Date *
Expected Grad Date
Election Area

North South East West Don't know
Questons or Comments
Should be Empty:

Request for Application and Information