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About the NLN

Centers of Excellence Consultant Interest Form
Deadline: October 31, 2011

* Required

*First Name:**
*Last Name:**
*Credentials:**
NLN Membership No.:
*Email Address:**
*Preferred Address:**	Business Home
*Address 1:**
Address 2:
*City:**
*State:**
*Zip:**
*Preferred Phone:**	Business Home
*Phone Number:**

Describe how you meet the criteria for appointment as a centers of excellence consultant (i.e., extensive experience and current knowledge of trends and issues in nursing education, commitment to excellence and innovation, openness to new ideas, and ability to review material objectively.):*	Characters Remaining


What experience have you had with the COE process?:*	Characters Remaining

This completed form must be accompanied by a copy of your Curriculum Vitae (no more than six-single spaced pages in length). Click “Browse” to search your computer and attach your CV file.

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