National League for Nursing

About the NLN

NLN AMBASSADOR PROGRAM INTEREST FORM

*Name/Credentials
*Title:
*Affiliating Institution:
*Preferred Mailing Address:
Address 2:
*City:
*State:
*Zip:
*Is This Address:	Home Business
*Preferred Phone:
Preferred Fax:
*Preferred Email:
NLN Membership Number:
If you do not know your NLN membership number, contact Kathy Young at kyoung@nln.org or 212-812-0306.

Why are you interested in assuming the responsibilities of an NLN Ambassador? What do you expect to gain from serving in this role? What do you think would be your greatest contribution as an NLN Ambassador? Please describe your involvement in the NLN at present and during the past few years. *Check this box to verify that you have completed this form voluntarily and agree to the following terms: You understand the responsibilities of an NLN Ambassador You agree to fulfill this role for two years and understand that you may be appointed to additional terms You have spoken with your dean/director/chairperson about this role and received her/his support to fulfill it Your NLN membership is current, and you agree to maintain that membership throughout the term of your appointment You are comfortable communicating via email and electronic communities You agree to keep current with NLN initiatives by using the NLN website, reading all communications from the NLN, familiarizing yourself with all NLN initiatives (e.g., certification, Centers of Excellence program), and contacting NLN staff for clarification and explanation as needed
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