NPAC-AIIPC | Association des infirmières et infirmiers practiciens du Canada » NPAC-AIIPC Board of Directors Nominations

The following items are required to be submitted for the nomination process:

Completed Nomination Form; with signed Declaration of Nomination (this form)
Resume or Curriculum Vitae of the nominee
Proof of NPAC-AIIPC Membership
Two (2) professional references (NPAC-AIIPC will obtain consent prior to contacting)

NPAC-AIIPC Board Position Applying to: *

President-Elect

Indigenous Director

Director at Large

I am an NP Registered in Canada as:

Province(s) of NP Licensure:

College License Number(s)

Are you currently sitting on another board of directors, or employed by a nursing/NP regulator?

No

Yes – please provide details:Yes – please provide details:

Nominee Full Name *

Nominee Email: *

Nominee Phone Number:

Best time to contact

Nominee Address:

City

State/Province

Zip/Postal

Country

Why are you interested in serving on the NPAC-AIIPC Board of Directors? *

What skills and or experience do you bring to NPAC-AIIPC that would add value for the Board Director position you are applying for?

Provide a brief overview of your practice history as an NP, including committee, board work, additional education, and future goals.

Is there anything else you would like to tell us that may be relevant to your nomination application?

CV Upload *

Maximum upload size: 516MB

Reference 1 Name *

Reference 1 Email *

Reference 2 Name *

Reference 2 Email *

I certify my willingness to stand for
nomination for the Nurse Practitioners’ Association of Canada (NPAC-AIIPC)
I certify that the information provided in this Nomination is accurate, to the
best of my knowledge.
I declare that I am a member in good standing of NPAC-AIIPC and will remain so for the term
of my office
I acknowledge that, in submitting this nomination, I have read and understand the nomination
information provided, including: the Job Description with the byaws. I am applying to, and the
Recruitment and Nominations Process of NPAC-AIIPC for Board Director positions
I authorize NPAC-AIIPC to share the information collected during my Nomination Process on
the NPAC-AIIPC website, by email, or in another format normally utilized by the Association
to inform members about the candidates for the Slate of Officers and Directors.
I understand that, if selected, this position will not be final until approved by the membership
at the AGM.

I have read and will comply with the declaration statements noted above.

Yes

Date