DNP Project Committee - Special Member Request

DNP Project Committee

Special Member Request
This form is used to request a special member for a DNP project committee. DNP project committees can have only one special member. Special members must be doctorly prepared (DNP, PhD, MD, DO, PharmD, etc.). The submitted form will automatically be sent to the College of Nursing-Office of Student & Academic Affairs (OSAA) to be routed for review and approval. OSAA will notify students and their DNP Project Committee Chair of the status of the request for a special member within 10 working days of submission.
I attest that my DNP Project Committee Chair has approved the special member requested for my DNP Project Committee.*

Yes I attestNo I do not attest
Student Name*

First NameLast Name
Student Email*
example@arizona.com
Student ID Number*
ID Number
Student Specialty*

Adult-Gerontology Acute Care Nurse PractitionerExecutive Health Systems LeadershipFamily Nurse PractitionerInformaticsNurse AnesthesiaPediatric Nurse PractitionerPsychiatric Mental Health Nurse PractitionerMS-DNPNurse Midwifery
Name of DNP Project Committee Chair*

First NameLast Name
Email of DNP Project Committee Chair *
example@arizona.com
The name of the Special Member *

First NameLast Name
Current Email Address for Special Member*
example@example.com
Upload Special Member CV / Resume *

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