ASPMN 2025-2026 Master Faculty Application
Contact information
Full Name:
First Name
Last Name
Academic/Professional Credentials:
Phone Number:
Email:
example@example.com
Mailing Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
membership
I agree to maintain ASPMN membership through 2030 if selected to serve as Master Faculty.
professional qualifications
Attach a current copy of your ANCC Pain Management Nurse Certification
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Attach a current copy of your CV
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Years of experience in pain management nursing:
Roles held (check all that apply):
Clinician
Educator
Consultant
Populations with experience (check all that apply):
Pediatrics
Adults
Geriatrics
I have experience teaching audiences of more than 20 participants.
Briefly describe your teaching experience:
Briefly describe your expertise with pediatrics, adult and/or geriatric patients with pain:
Please Provide Two Colleague References
teaching commitment
I am interested in the following ASPMN courses:
Geriatric Pain Management
Pain Certification Review Course
Advanced Pharmacology
Fundamentals of Pain Management
I agree to teach 1-2 courses per year at the regional or national level
I agree to participate in peer review of the courses I teach
I agree to follow established ASPMN course content and teaching methods,confining instruction to approved materials
I agree to assist with course revisions and updates as needed, and be willing to create and/or update slides
Name of Applicant
First Name
Last Name
Date Signed by Applicant
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Month
-
Day
Year
Date
Signature
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