Arkansas Action Coalition
Young Leaders Program
Nurses bring a unique, important perspective to health care but not enough nurses are in
important leadership positions to address Arkansas’ significant health care challenges. The
Arkansas Action Coalition is now accepting applications from nursing students who want to
change that dynamic.
The Young Leaders program will provide the BSN student the opportunity to explore the
leadership role of the Registered Nurse, in a selected setting, under the mentorship of a nurse
leader. This program will integrate concepts from Quality Safety Education in Nursing and the
landmark Institute of Medicine (IOM) report: The Future of Nursing: Leading Change, Advancing
Health.
This nursing leadership experience is being offered to student nurses in their junior or senior
year of a baccalaureate program, and will provide opportunities to explore various aspects of
leadership in nursing. These experiences will go outside the classroom, beyond the bedside,
and offer chances to work with nurse researchers, educators, clinicians and/or leaders. The
program participation begins in January, 2016, and requires a minimum of 8 meeting
commitment over 16 weeks, to be scheduled between the selected student and assigned
mentor. A nurse mentor will guide their experience. The student will also keep a log of
experiences and will complete an evaluation at the end of the program. The goal of this program
is to provide the student an opportunity to create or participate in a quality improvement project.
Application Timeline:
Application materials are due Nov 15, 2015. You will receive written notification regarding a
decision by December 15, 2015.
Application Forms:
It is the applicant’s responsibility to ensure that all application materials are turned in by the
deadline. The required materials include the following:
 Application form
 Resume with GPA
 Interests and expectations sheet
 Faculty reference form
 Faculty reference letter
 Sample contract form
 Two page essay identifying your leadership qualities and goals
For more information please contact:
Lauren Haggard-Duff PhD, MSN, RN, CNE
University of Arkansas
Eleanor Mann School of Nursing
606 N. Razorback Rd.
Fayetteville, AR 72701
Office Phone: # 479-575-3741
Fax: # 479-575-3218
Arkansas Action Coalition
Young Leaders Program
Application: Information Form
 The selection committee will not review incomplete applications.
Name: ______________________________________________________
Present Address: ______________________________________________
City: _______________________________ State: _______ Zip: ________
Student ID # ______________
Please indicate the best way to reach you:
Wireless Phone: __________________
Home Phone: ____________________
Work Phone: _____________________
E-mail Address: __________________
Have you currently satisfactorily completed all of your coursework to complete the junior
level?
Yes ____
No ____
If no, are you required to take additional courses this summer? Yes ____ No ____
If yes, what course will you be taking? _______________________________________
Scheduling Limitations:
Please describe your availability for this program:
Would you be able to arrange transportation to meet with your selected nurse mentor on
a weekly basis?
Yes ____
No ____
 Please attach a resume which includes education, work history, any
organizations or community involvement.
This form may be emailed to: [email protected]
Arkansas Action Coalition
Young Leaders Program
Application: Interests and Expectations
1. Please give a brief explanation of your goals and expectations for the leadership
nursing externship program.
2. How do you think your experiences, skills, or community activities may be useful to
you in working in a leadership setting? Why will these experiences be useful for us
to know about in evaluating you for this position?
____________________________
Signature of Applicant
_________________
Date
This form may be emailed to: [email protected]
Arkansas Action Coalition
Young Leaders Program
Application: Contract Form
Name: ________________________________________________________
The purpose of the Arkansas Action Coalition Young Leaders Program is to provide the
BSN junior or senior level nursing student the opportunity to explore the leadership role
of the Registered Nurse in a selected setting under the mentorship of a nurse leader.
Program Requirements:
 Student is expected to show up on time for experience.
 Student is required to wear professional attire appropriate for professionals and
lab coat as directed.
 Student is required to communicate and work with the preceptor.
 Student will complete evaluation after leadership externship experience.
 When problems are encountered, student will discuss with their faculty mentor.
 Student is required to adhere to policies and standards of organization in which
they are working.
 Signed contract indicates student’s obligation to adhere to program
requirements.
 Student is to participate or create a quality improvement project under the
direction of their assigned mentor.
 Student is to complete Program Evaluation at the end of their experience.
_____________________________
Signature
This form may be emailed to: [email protected]
Lauren Haggard-Duff PhD, MSN, RN, CNE
Office Phone: # 479-575-3741
Fax: # 479-575-3218
_______________
Date
Arkansas Action Coalition
Young Leaders Program
Faculty Reference
(Sample Cover Letter for Reference Form)
Dear UAMS CON Faculty Member:
I am submitting an application for the Young Leaders Program through the Arkansas
Action Coalition.
Will you please complete the evaluation form and return it to me. I must have my
application to the Arkansas Action Coalition by January 31, 2015.
______________________________
Name of Nursing Student (please print)
________________
Date
Submit the Faculty Reference form to:
This form may be emailed to: [email protected]
Lauren Haggard-Duff PhD, MSN, RN, CNE
Office Phone: # 479-575-3741
Fax: # 479-575-3218
Arkansas Action Coalition
Young Leaders Program
Application: Faculty Reference Form
Name of student: ____________________________________
Based on your experience with the student in the clinical setting, please evaluate the student on
the following items using the appropriate descriptor.
Very
Below
Good Good Average Average
Work Skills
1. Organizational skills
1
2
3
4
2. Technical skills
1
2
3
4
3. Communication skills
1
2
3
4
Attitudes towards work
1. Attitude toward learning new skills
2. Ability to adjust to new situations
3. Ability to work with others
4. Ability to work independently
1
1
1
1
2
2
2
2
3
3
3
3
4
4
4
4
Personal Qualities
1. Integrity
2. Attendance
3. Appearance
1
1
1
2
2
2
3
3
3
4
4
4
Capacity for Future Nursing Leadership
1
2
3
4
What are the applicant’s strengths?
What areas need further improvement?
What is your overall evaluation of this student compared to others at the same level in your
program?
Additional comments/concerns:
Faculty Name: _____________________________ Title: _______________________
Signature: __________________________________ Date: __________________