#WeAreMassNPs Story Form

#WeAreMassNPs Story Form

Thank you for participating in our #WeAreMassNPs campaign! Your story will help showcase the incredible work of Nurse Practitioners across Massachusetts.

Please take a few moments to share your story by filling out the form below.
Your story will be formatted as a Social Media post which we will share with you for your approval prior to publication.
Full Name (as you would like it to appear in your story write-up:*
Professional Credentials:*
Email Address: *
Mobile Phone (so that we can contact you if we have questions):*
For the context of your story, in what capacity are you working (or did you work) as a nurse practitioner:*

Providing Direct Patient CareEducator/FacultyOrganizational LeaderVolunteer or AdvocateResearcherOther
If other, please elaborate:
Please share your story below. Feel free to include your job title and where you work if you would like to include this. Please note there is no word limit but shorter stories will work best for our social media posts. We can reach out for more details if needed.
Your Story*
Please upload an image to accompany your story. It can be a headshot or a more candid or relaxed picture of you in your work place. Please be sure not to include any other individuals in your photo unless you have their permission to be included.*

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Release:
By submitting this form, you grant the Massachusetts Coalition of Nurse Practitioners (MCNP) the right to use, reproduce, and publish your submitted story, along with any accompanying photos, for promotional purposes related to the #WeAreMassNPs campaign. Your story may be shared on MCNP’s website, social media platforms, newsletters, and other communication materials.
Please acknowledge the following.*

I consent to the publication of my story and photo as outlined in the terms above.I understand I will be given an opportunity to review and approve my story prior to its publication and may request its removal at any time and at my discretion.
Please contact c.mckinnon@mcnpweb.org
if you have any questions.
Thank you!
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