MA Action Coalition (MAAC)
Willingness to Serve
Name _____________________________
Credentials ________________
Phone _____________________________
E-Mail ____________________
Organization (Employer) ______________________________________________
Professional Organization Affiliation _____________________________________
Brief Statement of Interest/Experience: _________________________________________
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Please identify your area of special interest: Please identify your choice
--- Academic Progression (includes Pathways, Diversity, Transfer Policy &
Employer Practices)
--- Nurse of the Future Competency Integration (Academic & Practice Settings)
--- Faculty (Maximizing Current Faculty & Expanding the Faculty Pool)
--- Scope of Practice (Advanced Practice Nurses)
Please send the completed form to Pat Crombie, Project Director, MAAC at
[email protected]
Thank you for your interest in this important work.