2023 Student Application for NSSNA Board
The information provided on this form will be used by the Nebraska State Student Nurses Association to verify eligibility to run for office. It is important that you give complete details concerning your application. Deadline for pre-slate is February 2nd , 2023 at 2359 Central.
Eligibility Requirements
Must meet all of the following to be eligible for office.
GPA of 3.0 or above
NSNA Member
Nomination for Candidacy Submission
Two Letters of Recommendation
BASIC INFORMATION
Student's Full / Legal Name
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First Name
Last Name
NSNA Membership Number :
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NSNA Membership Expiration Date
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Month
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Year
Date
Student Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Student Phone Number
*
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Area Code
Phone Number
Student E-mail
*
Academics
Name of School Attending
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Type of Program
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Associate
Baccalaureate
RN to BSN
Other
Anticipated Date of Graduation
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
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Day
Please select a year
2026
2025
2024
2023
2022
Year
Academic GPA
*
Unofficial Transcript
*
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Overall GPA must be included on document
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Offices for which you seek candidacy
In order of preference, list the positions(s) you are considering.
First Choice
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Second Choice
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Where did you hear about running for an NSSNA Board position?
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Facebook
Instagram
NSSNA Board Member
Faculty
Other
Student Documents
Details to include in the essay: Why you feel you are qualified for the office in which you are seeking candidacy, how NSSNA can improve communication between State and Local Chapters (please give specific examples), activities you participate in, list organization memberships, activities, offices and awards from: community, college before nursing school, nursing school.
Student Resume
*
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Student Essay
*
Browse Files
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REFERENCES:
Please list one educator and at least one community person who would recommend you for a scholarship. Please do not list the person who completes a scholarship recommendation for you.
Reference 1 Name (Position,Phone Number)
*
Reference 1 Letter of Recommendation
*
Browse Files
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Reference 2 Name (Position,Phone Number)
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Reference 2 Letter of Recommendation
*
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Submission Time
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Signature
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