USTNAI Election Nomination

Filing Date (Today)*

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Date
Hour MinutesAM/PM Option
Full Name*

First NameLast Name
Address

Street Address

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CityState / Province

Postal / Zip Code
Phone Number
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Candidates for the positions of President-elect and Vice President must be currently serving on the Executive Board.
Indicate Position Running For*

President -ElectVice - PresidentExecutive SecretaryAssistant Executive SecretaryTreasurerBoard Member
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UST Graduation Year*
Post Graduate*
Employment History
Current Employer*
Employment History*
Leadership Positions Held: Indicate USTNAI Positions or Leadership Positions held in other Professional nursing organizations (Include USTNAI chapter positions)*
Consent to Serve:

I, {fullName} hereby give consent to have my name listed as a nominee for the office of {indicatePosition} Term 2024-2026. I have reviewed the roles and responsibilities of the position I have been nominated. If elected, I promise to serve in the above capacity for the duration/tenure of the office, according to the provisions of the bylaws of the University of Santo Tomas Nurses Association International (USTNAI).
Provide a brief position statement/goals for running in this position and describe what difference you will make if elected in this office (candidacy platform). Limit to 120 words. Use additional sheets if necessary.*
Personal Attendance for Oath-Taking Ceremony:

As a nominee, I plan to attend the annual USTNAI convention this year and be personally inducted at the Oath-Taking ceremony during the Gala Night, if elected.
Conflict of Interest

In accordance with the Conflict of Interest Policy adopted by the USNAI Executive Board, it is required for your position in the UST Nurses Association International, Inc. that you complete this disclosure statement. This is confidential and will be available only to the Nominationa/Bylaws Committees and to the USTNAI Executive Board. Statements will be kept on file for five years by the USTNAI, Inc.

I hereby declare that I have read and understand the USTNAI Conflict of interest Policy. At this time, I do not have any conflict of interest or potential conflict of interest to disclose as delineated by the USTNAI Policy. I will update this disclosure statement annually whenever a potential or real conflict arises.
By checking the box below, this constitutes my electronic signature*

No potential Conflict of interestPotential conflict of interest exists
Signature*

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Date*

MonthDayYear
Date
Hour MinutesAM/PM Option
Should be Empty:

Employment History

Consent to Serve:

Personal Attendance for Oath-Taking Ceremony:

Conflict of Interest