National League for Nursing

Informatics Education Toolkit
Learning Activity Submission Form

CONTACT INFORMATION

*Required Fields

*Last Name:

*First Name:

Middle Initial:

*Credentials: (see format below)

*Phone Number:

Alternate Number:

*Email Address:

Affiliating Agency:

*Business Address:

Business Address 2:

*City:		*State:		*Zip:
Credentials format: Earned Degrees Only. Please list your highest earned credential first, then your license, then certification(s) and honor(s). EXAMPLE: MSN, RN, CNAA-A

*In one sentence, please describe the learning activity

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*Please describe the outcomes, objectives, or competencies related to the learning activity.

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*Please select where can this activity be used.

Education Level

*Category:
Computer Literacy
Information Literacy
Informatics*

*If Informatics: which curricular thread(s) is associated with the learning activity?

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