Expression of Interest Form
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
1. Why are you interested in serving on the Board of Directors? (Max 200 words)
2. What skills, experiences, or perspectives would you bring to the Board? (For example: policy, development, governance, leadership, etc. Max 300 words)
*
3. Board, Committee, or Leadership Experience
*
Yes
No
If yes, please describe briefly. (Max 200 words)
*
4. Skills and Competencies Please indicate your level of experience or knowledge in the following areas:
*
Rows
Basic
Moderate
Advance
Governance & Policy Development
Strategic or Systems Thinking
Financial Literacy/Oversight
Organizational Development
Equity, Diversity, & Inclusion
Communications Engagement
Health Policy/Nursing Practice Insight
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5. Availability & Commitment
Are you able to commit to:
Monthly Board meetings (2 hours, virtual)?
*
Yes
No
Unsure
In-Person Board meetings (1-2 times a term)?
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Yes
No
Unsure
Alternate-month check-in meetings (1 hour, mornings)?
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Yes
No
Unsure
Preparation time and occasional committee work?
*
Yes
No
Unsure
6. Equity & Representation (Optional)
NNPBC is committee to building a diverse and indusive Board. If you with, please share any lived experience, identity, or perspective you feel is important to representation on the Board (optional max 150 words)
7. Conflict of Interest Disclosure
Please disclose any actual or potential conflicts or interest (if applicable):
*
8. Additional Information (Optional)
Is there anything else you would like us to know? (Max 150 words)
9. Please advise if you are a NNPBC member and if so, which nursing designation:
Type a question
Yes
No
Please advise which nursing designation:
Declaration:
I confirm that the information provided is accurate and that I am willing to fulfill the responsibilities of a Board Director if selected.
Signature:
*
Date:
*
-
Month
-
Day
Year
Date
Please submit your completed Expression of Interest to:
bdesousa@nnpbc.com
Deadline to apply:
June 1, 2026, by 4:00 PM
Submit
EOI Form
Should be Empty: