American Nurse Advocacy Institute Application
Application Deadline: Friday, May 10, 2024
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
ANA/SNA Membership #
*
Approximate number of years as a member
*
Provide a brief response to the following questions.
1. Why should the State Nurses Association select you to attend this program?
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2. What has been your involvement with the State Nurses Association (or ANA) related to advocacy in the past one to two years?
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3. If you have not been involved, or would like to be more involved, how do you envision the Institute content assisting you to enhance your advocacy activities?
*
The number of seats is limited to 24; if selected, I agree to full participation throughout the year which entails participating in a one-hour conference call every other month following the face-to-face sessions in Washington, DC, and engaging in a series of activities or a project, mutually agreed upon by the state nurses association. Please initial in the box.
*
Submit
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