2027 PNAA iLDP Call for Faculty Registration Form

Email Address

example@example.com

Full Name

First NameLast Name

Your credentials, e.g. MSN, RN, CCM

Phone Number where you can be easily reached or texted

Please enter a valid phone number.Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Provide a copy of your current PNAA Membership Card

Local PNAA Chapter

Your position in your local chapter

Years of PNAA Membership

Place of Work & Position

Are you a graduate of iLDP

If yes, what year? If no, please write N/A

How do you want your name to appear on your Certificate of Appreciation?

Please indicate your interest to review final Project Management Plan to select the Top Three projects.

Provide a 200-word statement expressing your intent and commitment to be iLDP Faculty Coach 2027.

Please upload a professional headshot for use in the learning management system, PNAA publications (flyers, websites, announcements, etc).

Goal-Focused Coach Questionnaire: Think about your present ability to coach others as you answer these questions. Please answer ALL questions. Please indicate the extent to which you agree or disagree with the following statements. Do not spend too much time on any question. It is very important to rate your self accurately. If a question does not seem to apply to you at this time, for any reason – then check the “Neutral or Does not Apply at Present” box.

Rows	Very strongly Disagree	Strongly disagree	Disagree	Neutral or Does not apply	Agree	Strongly Agree	Very strongly agree
My coaching was effective in helping my coachee reach his/her goals
My coachee did not seem to value the time we spent having a coaching conversation
I know how to create an environment in which coaches feel free to present their own ideas
I purposefully used language that shows that I understood my coachee’s feelings
By the end of the coaching session my coachee had greater clarity about the issues he/she face
The goals we set when coaching were stretching but attainable
The goals we set during coaching were very important to my coachee
The goals we set during coaching were somewhat vague
I was very good at helping my coachee develop clear, simple and achievable action plans
When coaching, I spent more time analysing the problem rather than developing solutions.
I asked my coachee to report to me on progress towards their goals.
When coaching I found it difficult to discuss any performance shortfalls or failure to complete action steps

Attestation: Once selected, I commit to: the following iLDP Faculty roles for 2027:
Provide instruction and guidance to program fellows within the four program modules and offer one-on-one support and weekly feedback to program fellows regarding their professional growth and identify areas for improvement.

Track program fellows' progress and performance.

Be available for one-on-one virtual engagement with assigned fellow(s) biweekly via iLDP Cafe.

Be responsive to email communication from Program Directors.

I attest that the information to all facts in this application is true to the best of my knowledge and give permission for said facts to be verified or used for all PNAA relevant publications.

Signature

Congratulations! You have come to the END of the APPLICATION process. If you wish to review or edit previous sections, click on the "BACK" icon below AND NOT THE BROWSER BACK ARROW.

DO NOT HIT SUBMIT UNTIL YOU ARE ABSOLUTELY SURE YOUR APPLICATION IS COMPLETE. Once you hit SUBMIT your application is final AND CANNOT BE EDITED.

Thank you for your submission.

You will hear back from the iLDP Team between January 5 to 10, 2027.

Call for 2027 iLDP Faculty Coaches