2026 Board and Committee on Nomination Submission Form

2026 VNA Nomination and Consent to Serve Form

All submissions must be submitted by 11:59 pm on May 22, 2026. Please note that all information will be shared with the nominating committee, board, and VNA membership as needed.
Name*

First NameLast Name
First Name*
Last Name*
Credentials*
Daytime Phone Number*

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer*
Title*
E-mail*
VNA Chapter*
VNA Membership - all Board of Directors nominees must be members of the VNA. Please provide your member number below.*
PresidentSecretaryCommissioner on Nursing EducationCommissioner on Nursing PracticeCommissioner on Workforce IssuesDirector-at-Large, Frontline NurseCommittee on Nominations (3 open positions)
Relevant Experience/Roles

Please describe your relevant leadership experience in each category below. (75-word maximum per section). Your headshot/photo and information from your written submission will be shared with all VNA members for voting purposes
VNA/ANA/Chapter-level and VNF*

0/100
Professional/Work*

0/100
Community/Civic/Other*

0/100
Candidate's Statement
Please submit a statement describing why you are the ideal candidate for the position. (150-word maximum)
Candidate's Statement*

0/150
Upload Resume/CV*

Upload a File

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Recent Photo/Headshot (.jpg or .png)*

Upload a File

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OPTIONAL: As part of our commitment to ensure representation from diverse individuals and perspectives, we ask our potential candidates for board and nominating committee positions to provide demographic data.
AsianBlack/AfricanCaucasianMiddle EasternHispanic/LatinoNative AmericanPacific IslanderOther
Certification and Consent to Serve

By clicking the consent box below, I certify that I wish to run for the Virginia Nurses Association position indicated above. I understand the duties and responsibilities involved in this office and, if elected, I agree to serve and abide by the VNA bylaws, board policies and actions, and the ANA Code for Nurses. I understand that checking this box serves as my electronic signature.

I certify my understanding that VNA policy requires that no officer or director of the board shall serve concurrently as an officer or director of a board of another association or body if such participation might result in conflict of interest to VNA or the individual as determined by the board. I also understand that I may be requested to provide the Committee on Nominations with additional information to facilitate the development of the slate of candidates.

Further, I understand that checking the box below serves as my electronic signature and indicates my consent to serve if elected. My signature below further confirms that, in accordance with the above referenced VNA policy, I do not hold membership on a board of directors or other governing body of any other organization which could result in a conflict of interest.

I certify that the information on this form is true and accurate to the best of my knowledge.
I consent.
Please download, review, and sign the attached Conflict of Interest form, which is required annually of all Board and Nominating Committee members and candidates. Once you have completed, please scan the signed back page and email to lmckay@virginianurses.com.
Interview for Self-Nomination

Please pick ONE Interview Time slot below which you would be available to schedule your interview with the Committee on Nominations. Each interview will be 25-minutes.
Not a VNA Member?
Please understand, after you submit this form, we are unable to change your selection.
Optional: You may add a link in the space below to an article or video about yourself that you wish to share with VNA members.
Not a VNA Member yet? Click here to join!
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2026 VNA Nomination and Consent to Serve Form