Committee on the History of the
Massachusetts Nurse Practitioner
Name
*
First Name
Last Name
Email
*
example@example.com
Home Town/City
*
Mobile Phone Number
*
Please enter a valid phone number.
How many years have you worked/been working as a Nurse Practitioner?
*
I am still a Student
< 1 to 5
6 to 10
11 to 15
16 to 20
21 to 25
26 to 30
31 to 35
36 to 40
> 40
What is your NP Certification?
*
Adult/Gero
Family
Acute Care
Pediatrics
Psych
Women's Health
What is your practice specialty(s)?
*
Adult Primary Care
Family Practice
Pediatrics
Acute Care/Inpatient
Behavioral Health
Urgent Care
Specialty Practice
Other
If specialty practice or other, please specify.
What meeting style do you prefer?
*
In person only
Virtual only
Mix of both
Please indicate your area(s) of interest:
*
Volunteering to become a member of the committee
Volunteering to interview NPs or supporters in an oral history format
Sharing your memories of this time period as an NP through an oral history interview
Identifying artifacts such as news articles, curriculum related to this period of early NP education and Practice
Additional comments:
Submit
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