FNSA Constituency Application Form

FNSA Constituency Application Form

Submit this form to apply for or renew FNSA constituency status. Ensure all sections are completed accurately. This application must be submitted annually and can be submitted at the Annual House of Delegates meeting.
SECTION 1: Chapter Identification
Official School Name - Don't shorten the name*
Name of School Chapter (if established)
Nursing Program Type*
School Mailing Address (add campus if needed)*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Chapter Email Address*
example@example.com
Chapter Phone Number (if applicable)
Please enter a valid phone number.
SECTION 2: Membership Verification
Number of Active NSNA Members*
We certify that our school maintains a minimum of ten (10) active NSNA members in good standing and dues have been remitted to NSNA.*

We certify that our school maintains a minimum of ten (10) active NSNA members in good standing and dues have been remitted to NSNA.
SECTION 3: Bylaws Compliance
Upload Current Chapter Bylaws (PDF or .docx required)*

Cancelof
Is this a first-time constituency application?*

YesNo
First-time chapters must submit a copy of chapter bylaws aligned with NSNA Areas of Conformity and FNSA Bylaws to the FNSA First Vice President at 1stvicepresident@fnsa.net.
Certification of Alignment*

We affirm that our chapter bylaws incorporate the NSNA Article III – Purpose and Functions and align with FNSA Bylaws requirements.
The purpose of the chapter shall include:
- Contributing to nursing education to provide the highest quality healthcare
- Providing programs representative of professional interests and concerns
- Supporting development of the whole person and professional role
- Influencing healthcare and nursing education through legislative activities
- Promoting participation in community affairs toward improved healthcare
SECTION 4: Officer Information
Chapter President Name*
Chapter President Email*
example@example.com
Chapter President Phone Number
Please enter a valid phone number.
Chapter Secretary Name*
Chapter Treasurer Name*
Faculty Consultant Name(s)*
Faculty Consultant Email(s)*
example@example.com
SECTION 5: Delegate Representation
FNSA Delegate Representation:
One (1) delegate per fifteen (15) members or major fraction thereof.
Membership count is calculated twenty-five (25) days prior to convention.
Based on your membership count, how many delegates do you anticipate seating?*
SECTION 6: Annual Compliance Certification
Annual Compliance Acknowledgment*

We understand that constituency status must be renewed annually.We understand that both NSNA and FNSA Official Applications must be submitted annually.We understand that failure to comply with FNSA Bylaws may result in removal of constituency status by vote of the Executive Board.We affirm that all information provided is accurate and submitted by elected student officers.
SECTION 7: Signature
Name of Elected Student Officer Submitting Form*
Officer Position*
Digital Signature*

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FNSA Constituency Application Form

SECTION 1: Chapter Identification

SECTION 2: Membership Verification

SECTION 3: Bylaws Compliance

SECTION 4: Officer Information

SECTION 5: Delegate Representation

SECTION 6: Annual Compliance Certification

SECTION 7: Signature