oena delegate form

Name

First NameLast Name
Completed applications must be recieved by Sunday JUNE 1st at 1800.

Applications recieved late may not be considered for General Assembly 2026, Phoenix, Arizona

REMEMBER: Activity summaries from the previous calendar year (January 1, 2025 until December 31, 2025)
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
What is your current role/title with your employer?
What is your current role/title within ENA
YesNo

Please select and enter points from all applicable categories that apply from January 1, 2025 to December 31, 2025.

At the end of the form total your points, and provide any supporting data, certificates or documentation to support selected criteria
Served as an OHIO ENA (OENA) delegate at 2025 General Assembly (10 Points)
Attended as a member at large to at least 5 out of 6 OENA meetings (10 points); Attended as a member 4 out of 6 OENA meetings (7 points); Attended 3 out of 6 OENA meetings (5 points). OENA secretary to review attendance records to validate. SELECT only one value
Attended as a member at large to 3 or more SIG meetings in 2025 (5 points); Attended as a member at large 1 or 2 SIG meetings (1 point). OENA secretary to review attendance records to validate. SELECT only one value
Served as an OENA officer (15 points)
Membership on an ENA taskforce or liaison workgroup National level (15 points), OENA (10 points). Please list out the committees with claimed points & upload proof. For example official meeting minutes &/or sign in sheets
File Upload proof of service on committees, taskforce &/or special interest group

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Participate in a committee or team recognized and officially representing OHIO ENA to promote emergency nursing. Examples include teams participating in resolution proposals created, submitted, &/or presented at GA; Ohio Pediatric readiness teams; OENA recognized volunteering opportunities to represent state council. Please list out the committee, brief description of activities and role (5 points).
File Upload proof of representation on committees. Examples of proof include offical meeting minutes and/ or attendance.

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Attended OENA awards banquet (NA for 2025)
Attended National ENA State & Chapter Leadership Meeting, SCLO/LO (15 points)
File Upload proof of attendance

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Attended ENA National Annual EDUCATION New Orleans 25 conference (15 points)
File Upload proof for example your CE's

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Attended ENA Day on the Hill DOTH (10 points)
File Upload

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Attended any additional ENA educational symposiums or offerings outside of OHIO (5 points)
File Upload

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Received any awards or recognition for contributions to Emergency Nursing, such as but not limited to FAEN designation (includes maintaining current status &/or renewal), daisy nomination/award, or hospital award (10 points-- list the award & dates received)
File Upload

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Achieved, holds current, &/or renewed BCEN certifications CEN, CPEN, TCRN, CTRN, CFRN, CBRN (claim 10 points per certification & list each certification )
File Upload

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SANE-A SANE-P GFN-C (Generalist Forensic Nurse) or AFN-C (Advanced Forensic Certification Board) advanced certifications
File Upload

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Achieved, maintains CURRENT, &/or renewed additional healthcare related specialty certifications as recognized by AACN such as CCRN, NEBC, NPD (10 points per certification & list each certification). Advanced certifications does NOT include ACLS, PALS, or neonatal resuscitation (NRP).
File Upload

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Achieved, maintains CURRENT, &/or renewed additional healthcare related licensure such as National Registry &/or state EMS cards (10 points per certification & list each certification)
File Upload

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TNCC course State Faculty (15 points) Director/Instructor (10 points); TNCC current provider card (5 points)
File Upload

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ENPC course State Faculty (15 points) Director/Instructor (10 points); ENPC current provider card (5 points)
File Upload

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TNAC instructor/provider
File Upload

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ENTP instructor/provider
File Upload

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Participated in ATCN / ATLS course (5 points)
File Upload

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Presented NON- work related lectures in Emergency Healthcare: list the topic, date, location/host of lecture (5 points per topic)
File Upload-examples include the agenda, &/or your presentation

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Conducted emergency nursing research, quality improvement, or evidence-based practice initiatives: list the names of the projects (5 points)
yesno
File Upload example of synthesis tables, protocols, IRB approval

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Published a peer-reviewed article such as JEN or other healthcare journals in 2025. List the article citation with the doi (5 points per article)
Volunteer activity within Healthcare such as wellness activities, health fairs for the general public, schools, etc. from January 2025 to December 2025. List the sponsoring agency, date, time and activity completed (5 points)
File Upload

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Recruited new members to ENA. List each member recruited in 2025 (1 point per member)
File Upload membership portal contains proof

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Participation in our organization governance is important; fellow professional organizations have this as a category when applying to participate in programs. Please provide a copy of the email confirmation that you participated in the 2025 ENA national elections &/or OENA 2025 state elections.

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POINT TOTAL:
Please add any supporting information or notes you feel would assist the OENA Membership Liaison with the review of your application: For example are there any other activities that you have completed related to emergency healthcare not listed.
Please add any supporting documents you feel would assist the OENA General Assembly Lead and OENA Board of Directors with the review of your application.

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All communication from OENA regarding this application will occur via email. If you have any questions please enter them here. Announcement of the slate of delegates will occur at the JUNE In-Person OENA meeting. Attendance is recommended for JUNE meeting; Attendance REQUIRED for AUGUST In-Person meeting
Signature: My signature verifies that I am interested in serving as a 2026 OENA delegate at General Assembly. Addition prep-work, attendance at OENA August meeting, completion of ENA delegate on-line training to prepare for GA is encouraged. Participation in ongoing post- GA activities is also encouraged

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Please select and enter points from all applicable categories that apply from January 1, 2025 to December 31, 2025.