NLN CNEA On-site Program Evaluator Application

Basic Information

Thank you for your interest in volunteering with NLN CNEA. This application form is required for prospective on-site program evaluators. This form is to be completed in its entirety by either the nominator or self-nominator.

Before beginning this form, please have the following documents available for upload:

Personal statement
- A statement that describes why you want to be an NLN CNEA on-site program evaluator. This statement should be no more than two double spaced pages. The statement should briefly address the following:
  
  a.    your current knowledge of higher education, nursing education and practice issues;
  
  b.     an understanding of the application of continuous quality improvement to the accreditation process;
  
  c.     evidence of contributions to the nursing profession through scholarship, practice and professional service; and
  
  d.    your ability to apply the core values of the NLN (caring, diversity and inclusion, excellence, integrity) to the accreditation process. Please provide examples as an educator or as a practice partner that supports your demonstration of the NLN core values.
Current resume or CV

2 letters of recommendation
- Two letters of recommendation citing your qualifications for the role of on-site program evaluator. One letter of recommendation must be from the head of your nursing program or professional practice site, addressing the criteria as well as support for your participation as an NLN CNEA on-site program evaluator. If you are the head of a nursing program or practice site, please attach a letter of support from your immediate manager. The letters should address your current knowledge of higher education, nursing education, and practice issues; your understanding of the application of continuous quality improvement to the accreditation process; demonstrated excellence in communication; evidence of contributions to the nursing profession through scholarship, practice and professional service, and evidence of your ability to apply the values of the NLN (diversity, caring, integrity and excellence) to the nursing education accreditation process.
  
  If you are nominating someone, address the rationale for your nomination based upon the criteria listed above. The nomination letter serves as one of the two letters of recommendation. Please note that members of the NLN CNEA Board of Commissioners and members of the NLN Board of Governors are unable to provide a letter of recommendation for this application

Begin by filling out fields requesting basic information. At the end of the form there will be an opportunity to upload supporting files for the application. You will receive an email confirmation when the application has been successfully submitted for review.

If you have any problems with this form, please email cneaaccreditation@nln.org.

1. First Name *This question is required.

2. Last Name *This question is required.

3. Credentials *This question is required.

4. Home email address, if applicable

5. Home telephone

6. Cell phone number

7. Home address

8. Printed name of nominator (if not self-nominating)

9. Select documents to upload:

Personal statement
Current resume or CV
2 letters of recommendation

File: {{filename}} delete

Employment Information

Job Title

Employer Name

12. Employer Address

13. Work email address, if applicable

14. Work phone, if applicable

16. In what state do you have an active, unencumbered nursing license?

18. If yes, type of certification

20. If yes, NLN member number

Space Cell	Yes	No
Practical / Vocational Nursing	Practical / Vocational Nursing: Yes	Practical / Vocational Nursing: No
Associate Degree	Associate Degree: Yes	Associate Degree: No
Diploma (RN)	Diploma (RN): Yes	Diploma (RN): No
Baccalaureate	Baccalaureate : Yes	Baccalaureate : No
Masters	Masters: Yes	Masters: No
Post Masters Certificate	Post Masters Certificate: Yes	Post Masters Certificate: No
DNP	DNP: Yes	DNP: No

23. If yes, what agency or agencies?

25. If yes, which agency or agencies?

26. Consent to serve

As a trained NLN CNEA on-site evaluator, I agree to do a minimum of one accreditation visit per year. I also attest to the fact that I am only participating in accreditation site visits for NLN CNEA and do not serve in any capacity as an accreditation volunteer for another nursing education accreditation agency. *This question is required.

Clear

Signature of

NLN CNEA On-site Program Evaluator Application

Application for NLN CNEA On-Site Program Evaluator