National League for Nursing - Faculty DevelopmentLEADERSHIP DEVELOPMENT PROGRAM FOR SIMULATION EDUCATORS - APPLICATION FORM 2015
Education (include basic preparation through highest degree held)
Institution (Name, City, State)
Major Area of Study
Year Degree Awarded
If you are employed in a school of nursing, which types of programs are offered at that school? Select all that apply.
If you are employed in a school of nursing, in which programs do you generally have teaching, advisement, and leadership responsibilities?
Indicate the ONE program where you have the MAJORITY of your teaching, advisement, and leadership responsibility.
Present position and description of responsibilities. Include academic rank if appropriate.
Previously held positions in nursing education (provide your title and/or rank, name of school, location of school, and brief description of responsibilities).
What is the total number of years you have held a full-time faculty position?
What is the total number of years you have held a part-time faculty position?
Other relevant employment or experience:
Research/Grant Experience (if applicable):
Awards and Honors:
Publications (selected publications, last three years):
Presentations (selected presentations, last three years):
Please be concise when answering the following questions. One or two paragraphs for each question is sufficient. Be sure to answer all parts of each question.
1. Briefly describe the goals you wish to accomplish by participating in this program. Include your career goals.
2. Several of the planned activities for this program involve group work. What areas of expertise do you bring that would contribute to the overall learning of other members of your cohort, and what strengths do you bring that will promote effective group work?
3. Describe a creative teaching-learning innovation using simulation that you have developed, why you developed it, the success you had in implementing it, and what you learned from the experience.
4. Describe instances when you have functioned as a leader in nursing education.
Please upload the appropriate administrator’s letter on school letterhead indicating the school’s support of your attendance, January - December 2015. This letter should include acknowledgement of payment of your tuition, lodging and transportation for conferences, as well as support for participation in all activities.
Note: File names should start with, "SimLeader-letter_yourlastname".
You will receive a confirmation email when your application is received and complete. If you do not receive an email within five business days of your submission, please contact the Tigist Bishaw at 202-909-2503.
PLEASE BE SURE TO:
Read through your application to be sure that you have completed all sections.
Submit your application as stated in the directions above.
Appropriate administrator's letter (e.g., dean/director) addressing your leadership abilities or potential, and documenting her/his support for your participation in this program. Applicants will not be considered if the appropriate administrator’s letter does not accompany the application.
This is a highly competitive program. We encourage you to have someone review your application and provide feedback before you submit. We do look for a concise answer to the questions - longer is not necessarily better. Here are some questions to ask yourself as you prepare your answers to each question.
Are your goals specific and achievable?
Does the answer to the question on group work reflect an evaluation of your own strengths in that area: perhaps cite an example or two.
Is the teaching/learning innovation you describe really creative? Even if it had limited success, do the lessons that you describe reflect learning that can be used when planning future simulation experiences?
Do the instances you cite when you have functioned as a leader reflect that you have already taken some steps in developing leadership skills?
All application materials must be received by September 30, 2015 at 5:00 PM EST.
Note: Please click only once, the form may take several seconds to process.