Nomination Form for Board of Commissioners and Nominating Committee

Thank you for your interest in serving as a member of the CCNE Board of Commissioners or Nominating Committee. All fields below must be completed by the nominee and submitted by March 24, 2022.

For questions, please contact CCNE Accreditation Manager Renee Kalan at rkalan@ccneaccreditation.org or 202-887-6791 x230.

Nominator Information

Nominator: *

I am self-nominating for this position

I am being nominated by someone else for this position

Nominator Full Name: *

Nominator Title: *

Nominator Institution: *

Nominator Email: *

Nominator Phone: *

Nominee Information

Nominee is seeking election to: *

CCNE Board of Commissioners

CCNE Nominating Committee

Board of Commissioners Position: *

Chief Nurse Administrator (e.g., dean or dean equivalent)

Faculty

Practicing Nurse

Professional Consumer

Nominee First Name: *

Nominee Last Name: *

Credentials (e.g., Phd, RN, APRN-BC): *

Title: *

Institution/Employer: *

Institution City, State: *

Institutional Affiliation (e.g., public or private, non-profit or for profit, religious or secular): *

CCNE-Accredited Program(s) at Institution (check all that apply): *

Are you a CCNE On-Site Evaluator? *

Yes, for baccalaureate & graduate nursing education programs

Yes, for entry-to-practice nurse residency programs

Yes, for both nursing education and entry-to-practice nurse residency programs

No

Number of CCNE Evaluations Completed: *

Email: *

Phone: *

Mailing Address: *

Mailing City, State: *

Mailing Zip Code: *

CV/Resume

Upload a copy of your CV/resume. This file should be in PDF format and named as follows: FIRSTNAME_LASTNAME_CV.pdf

Upload a copy of your current CV/resume: *

General Considerations

A. How will your education and/or experience support your role and position on the CCNE Board of Commissions or Nominating Committee? *

B. Describe any specific experience you have with CCNE (e.g., hosting a CCNE evaluation, serving on a committee, serving as an evaluator). *

C. What motivates you to be on the CCNE Board of Commissioners or Nominating Committee? *

Consent Statement

I am willing to serve if selected for nomination and elected by the programs accredited by the Commission on Collegiate Nursing Education (CCNE).

I hereby agree that if I am elected to a position on the CCNE Board of Commissioners or Nominating Committee, I will avoid all conflicts of interest, whether perceived or actual. I will also conduct myself in a manner that is consistent with the duty of loyalty and trust I owe the Commission.

I agree to disclose to the CCNE Executive Director and to the Board of Commissioners any position of leadership that I hold in any nursing or related organization. I agree to disclose to the CCNE Executive Director and to the Board of Commissioners any specific matters over which I may have a conflict of interest. I agree not to influence any matters where such a conflict exists.

If I am elected to a position on the CCNE Board of Commissioners, I further agree not to serve as a consultant to a baccalaureate, graduate, or residency/fellowship program in nursing within CCNE’s scope of accreditation review during my tenure on the Board. I also understand that, if I am a CCNE on-site evaluator and elected to the Board, I will be made “inactive” as a CCNE evaluator during my tenure on the Board.

If I am elected to a position on the CCNE Board of Commissioners, I understand that I may not concurrently serve on the Board of Directors of the American Association of Colleges of Nursing (AACN). Additionally, individuals serving on the CCNE Board or Nominating Committee are not permitted to concurrently serve on the decision-making body of another national nursing accrediting organization (or its parent organization).

I understand that, if elected, CCNE will reimburse me for actual expenses incurred for and directly related to Board of Commissioners or Nominating Committee meetings, in accordance with CCNE policy and travel guidelines.

Nominee Signature (sign on screen or draw signature with mouse): *

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