Nominating Personal Consent To Serve & Position Qualification Statement

Questions marked with * are mandatory.

*First Name:*Last Name:
*Work Address:
*Zip code: *Country:
Work Phone:Email:
Home Address:
Zip code: Country:
Home Phone:Mobile:
Personal E-mail:

* I consent to serve for the following position:
President-elect Serves a two-year term immediately followed by a two-year term as President. The President-elect serves as the Board liaison to the SSPC and PSNCB. The President-elect performs other duties as assigned by the President.
Secretary-Treasurer Serves a two-year term. Monitors the financial status and reports on the budget to the Board and membership annually. Maintains the record keeping for all meetings. Authorizes Society expenditures.
Director (2) Serves a two-year term. Participate in the development and implementation of the strategic plan of the Society.
* By checking this I consent to serve for the position. Today's Date: Month: Day: 2016

Candidates must meet the following criteria:

  • The nominee is an active member for a minimum of two years of the ASPSN.

  • The nominee is actively engaged in and/or has special knowledge related to plastic surgical nursing. A minimum of three years is recommended.

  • Nominees must maintain a CPSN or CANS certification.

  • The nominee participates in plastic surgical nursing-related activities on a national and/or local level. Experience as a national officer or committee member for ASPSN and/or other nursing organization(s) is required.

  • Required to sign a disclosure statement

  • The nominee submits a Candidate Application Packet that includes the following:
    • Nomination Form
    • Curriculum Vitae or resume
    • Candidate’s statement of goals (200 words or less)
    • Philosophy of Practice (200 words or less)

*Years of ASPSN Membership
*Educational Background/Significant Achievements/Career Highlights/awards/ASPSN Committee Work/Publications
(please limit to your most current – up to six)
*Affiliation with ASPSN and other professional organizations
*Qualifications for this position
*Position Statement/Goals
*Philosophy of practice (200 words or less)
*Two letters of recommendaton with knowledge of your professional and leadership abilities
Letter 1

Letter 2
*Please attach a personal photo for publication & display (portrait type head shot) Photo

If you are nominating someone else:

Your First Name:Your Last Name:
Nominee Information:
I Nominate:
Nominee First Name:Nominee Last Name:
Work Address:
Work Phone:Home Phone:
By checking this the nominee consents to serve the position.
Today's Date: Month: Day: 2016

American Society Of Plastic Surgical Nurses
500 Cummings Center, Suite 4400, Beverly, MA 01915
Phone: 978-927-8330 | Fax: 978-524-0498