USTNAI Candidate Nomination Form

UNIVERSITY OF SANTO TOMAS NURSES ASSOCIATION INTERNATIONAL, INC.
USTNAI ELECTION NOMINATION FORM

NOMINATIONS AND ELECTIONS COMMITTEE
Filing date

MonthDayYear
Status of Nomination
Full Name

First NameLast Name
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email Address
Phone Number

Area CodePhone Number
Candidates for the positions of President-elect and Vice President must be currently serving on the Executive Board.
Indicate position running for
Upload Your 2x2 Picture

Upload a File

Cancelof
Upload your latest CV

Browse Files
Accepts pdf, doc, docx, xls, xlsx, jpg, gif only Cancelof
UST Graduation Year
Post Graduate
Employment History
Current Employer
Employment History (from most recent) list
Leadership Positions Held: Indicate USTNAI Positions or Leadership Positions held in other Professional nursing organizations (Include USTNAI chapter positions)
Consent to Serve:

I, {fullName} hereby give consent to have my name listed as a nominee for the office of {indicatePosition} Term 2024-2026. I have reviewed the roles and responsibilities of the position I have been nominated. If elected, I promise to serve in the above capacity for the duration/tenure of the office, according to the provisions of the bylaws of the University of Santo Tomas Nurses Association International (USTNAI).
Provide a brief position statement/goals for running in this position and describe what difference you will make if elected in this office (candidacy platform). Limit to 120 words. Use additional sheets if necessary.
Personal Attendance for Oath-Taking Ceremony:

As a nominee, I plan to attend the annual USTNAI convention this year and be personally inducted at the Oath-Taking ceremony during the Gala Night, if elected. (Please also include a date and electronic signature entry after this statement). 🙏
Conflict of Interest:

In accordance with the Conflict of Interest Policy adopted by the USNAI Executive Board, it is required for your position in the UST Nurses Association International, Inc. that you complete this disclosure statement. This is confidential and will be available only to the Nominationa/Bylaws Committees and to the USTNAI Executive Board. Statements will be kept on file for five years by the USTNAI, Inc.

I hereby declare that I have read and understand the USTNAI Conflict of interest Policy. At this time, I do not have any conflict of interest or potential conflict of interest to disclose as delineated by the USTNAI Policy. I will update this disclosure statement annually whenever a potential or real conflict arises.

By checking the box below, this constitutes my electronic signature
Conflict of Interest
For Nomination and Election Committee Use
Comments
Signature
Date Signed

MonthDayYear
DateHourMinutesAM/PM Option
Should be Empty:

USTNAI ELECTION NOMINATION FORM