Florida Nurses Association

Committee/Task Force

Declaration of Interest Form

2014-2015

This year we have several opportunities to participate at the state level at committees and task forces. Please use this form to apply for the committee or task force of your choice. The Application is due by October 30. Current committee members are welcome to re-apply.

I am interested in the following committee(s). (Select up to two)

Please check the box next to the desired committee. If interested in more than one, please designate your first and second choice.

Email this form to or fax it to 407-896-3261

Check your choice(s) / Name and Function of Committee / 1st choice / 2nd
choice
Bylaws Committee
This committee will work on Bylaws review and revisions for the 2014 Member Assembly.
Reference Committee
Solicits and develops issues proposals for consideration by the Membership Assembly at the 2014 and 2015 Membership Assemblies.
Certificate of Need Workforce Issues-This committee will explore the ramifications of deleting the requirement of the Certificate of Need process.
Membership Committee
Works with the Director of Programs and Member Engagement and the Vice-President on membership retention and recruitment initiatives. This year additional members will be added to this committee as a part of the Membership Task Force as voted on by the Membership Assembly.
Task Force on the Nurse Licensure Compact
Based on the 2012 Reference Proposal, this task force will examine the feasibility and ramifications of Florida joining the Nurse Licensure Compact.
Leadership Development Committee
This committee will work on programs to provide education and activities for succession planning to ensure leaders are being identified and developed for the future.
This could include, webinars, education session, videos or other activities as developed by the committee and approved by the Board of Directors as well as oversight over the FNLA.
I am willing to serve as chair of my selected committee. (Indicate by checking the box on the left).

Volunteer Data Form

Meetings are usually held by conference call but committee may determine need for a face to face with agreement of the members. Schedule is usually quarterly unless additional meetings are deemed necessary by the members of the committee. Time of day or night also determined by committee members.

Name______Email address______

Current District______Phone number______

Address______

City, State, Zip______

Please write a BRIEF statement about your choice and your reason for volunteering below:

Email this form to or fax it to (407)896-9042.