2027 Nurse Leadership Academy Fellow Registration

2027 Nurse Leadership Academy Application
- Registrant Name
  
  First NameLast Name
- Registrant Credentials
- Registrant Organization
- Registrant Title
- Registrant Email Address
  example@example.com
- Registrant Work Phone Number
  Format: (000) 000-0000.
- Registrant Cell Phone Number
  Format: (000) 000-0000.
- Registrant Home Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Are you a member of VNA/ANA?
- RN License Number
- RN License State
- Who will fund your participation in the Nurse Leadership Academy?
- As a Fellow in the Nurse Leadership Academy, I understand that I am required to attend all educational sessions, meet with my mentor monthly, and complete a total of 8 hours of shadowing with my mentor during September and October.
- Signature
- Purpose:
  
  The Rural & Underrepresented Nurse Leadership Scholarship supports the development of emerging nurse leaders who serve in rural, underserved, or historically underrepresented communities. The scholarship aims to expand pathways to leadership for nurses whose backgrounds, practice settings, or lived experiences contribute to advancing health equity, improving access to care, and strengthening the nursing workforce.
  
  Ideal Candidates May Include Nurses Who:
  - Work in rural or critical access hospitals, community clinics, or other underserved care settings.
  - Provide care to vulnerable or marginalized populations, including low income, aging, or geographically isolated groups.
  - Come from underrepresented backgrounds in nursing leadership, including first-generation professionals and individuals from communities with historically limited access to leadership development.
  - Are committed to applying their leadership learning to improve equity, quality, and access within their local communities.
  - Seek to expand their influence and impact through participation in the Nurse Leadership Academy.
  Scholarship Impact:
  
  This scholarship supports nurses who are uniquely positioned to transform care delivery in areas where strong leadership is most needed. By investing in nurses from rural and underrepresented communities, the program advances health equity, strengthens local workforce capacity, and cultivates the next generation of diverse nurse leaders.
- Please describe your current nursing role and the community or population you serve. Include how your setting experiences limited access, workforce shortages, or health disparities.
  
  0/300
- How do your background, lived experiences, or professional pathway align with the mission of this scholarship? Examples may include coming from an underrepresented background in nursing leadership, being a first-generation professional, or practicing in a community with limited leadership development opportunities.
  
  0/300
- Describe a meaningful experience in which you provided care to a vulnerable, underserved, or marginalized population. What challenges did you observe, and how did your actions or perspective contribute to improved care or understanding?
  
  0/300
- Describe a leadership role or moment that demonstrates your potential as an emerging nurse leader. Formal titles are not required. Examples may include mentorship, advocacy, quality improvement, or leading change at the unit or community level.
  
  0/300
- What does health equity mean within your specific community or practice environment? Share one way you have advanced, or hope to advance, equity, quality, or access to care.
  
  0/300
- How will participation in the Nurse Leadership Academy support your development as a nurse leader? Describe the skills, knowledge, or networks you hope to gain.
  
  0/300
- How do you plan to apply what you learn in the Academy to benefit your workplace or local community? Be specific about the anticipated impact on care delivery, access, workforce strength, or equity.
  
  0/300
- What is your leadership vision for the next 3–5 years, and how does this scholarship support that goal?
  
  0/300
- Please upload a letter from your direct supervisor demonstrating their support of your participation in the program. The letter should highlight the applicant’s leadership potential for professional growth, and describe how the supervisor will provide the necessary time, resources, and managerial support to ensure all requirements are fully met by the applicant, including:
  - attending virtual sessions
  - supporting mentorship expectations
  - attending in person graduation at the 2027 Virginia Nursing Impact Summit
  The letter must include:
  - supervisor’s name, title, and organization
  - a statement of support for your participation
  - acknowledgment of the program’s time commitments and scheduling flexibility
  - supervisor’s signature and date
- Leadership Support Letter
  
  Cancelof
- The Nurse Leadership Academy (NLA) Mentorship Program is a structured 10-month professional development experience designed to cultivate self-aware, resilient, and growth-oriented nurse leaders. Grounded in the AONL Leader Within domain, the program emphasizes that effective leadership begins with self-reflection, personal accountability, and intentional career development.
  
  Through guided mentorship, experiential learning, and participation in NLA sessions, mentees will integrate leadership concepts into practice while building meaningful professional relationships. This program supports both personal and professional growth, preparing nurses to lead with authenticity, adaptability, and purpose.
  
  Mentor Qualifications
  
  Mentors selected for participation must demonstrate:
  - Hold a formal leadership role within or outside the organization
  - A minimum of two years of leadership experience, preferred
  - Hold a nursing degree
  - Exhibit a strong commitment to developing and supporting others
  - Demonstrate willingness to share practical leadership insights and experiences
  - Possess effective interpersonal, communication, organizational, and leadership skills
  - Show flexibility, adaptability, and openness to continuous learning
  - Have the time, availability, and organizational support necessary to fulfill the mentorship role
  - Promote and value diversity, equity, and inclusion
  - Maintain a professional, approachable demeanor that fosters trust and engagement
  Mentor Responsibilities and Expectations
  
  This role is essential in creating a structured, supportive, and growth-focused mentorship experience. Mentors are expected to actively support the professional growth and development of their assigned mentee through the following:
  - Facilitate the mentee’s understanding of day-to-day nursing leadership roles and responsibilities
  - Guide the application of knowledge gained from NLA sessions into practice
  - Adhere to the NLA session timeline to reinforce learning and ensure progressive development
  - Collaborate with the mentee to develop:
    
    A 1-year leadership development plan during the program
    
    A 1–3 year career progression plan beyond program completion
  - Meet with the mentee at least once per month to support ongoing development
  - Coordinate and facilitate a “Day in the Life of a Nurse Leader” shadow experience
  - Foster a psychologically safe and supportive environment that promotes:
    
    Open and transparent communication
    
    Mutual respect and trust
    
    Discussion of expectations, stressors, and learning needs
  - Provide constructive, timely feedback and positive reinforcement
  - Assist the mentee in identifying strengths, opportunities for growth, and development strategies
  - Promote accountability by establishing goals and monitoring progress between meetings
  - Facilitate professional networking opportunities, as appropriate
  - Maintain confidentiality and uphold professional boundaries at all times
  Please identify your selected mentor below.
- Mentor Name
  
  Mentor First NameMentor Last Name
- Mentor Credentials
- Mentor Title
- Mentor Organization
- Mentor Email Address
  example@example.com
- Mentor Phone Number
  Format: (000) 000-0000.
- Organizations and individuals will receive an invoice by email for registration.
  
  VNA Member: $1,795 per registrant
  
  Non-Member: $1,995 per registrant
- Invoice Amount
- Organization or Individual to Be Invoiced
- Contact Name for Invoice
  
  Invoice First NameInvoice Last Name
- Contact Email for Invoice
  example@example.com
- Invoicing Address
  
  Invoice Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Invoicing Phone
  Format: (000) 000-0000.
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2027 Nurse Leadership Academy Application