CLN BOARD OF DIRECTORS
Application for Terms Beginning Summer 2017
Serving on the Board of Directors is a leadership opportunity that will allow you to be creative, influential
and connected to people and organizations involved in promoting nursing education. We appreciate your
submitting your credentials to serve the CT League for Nursing.
NAME
______________________________________________________________
ADDRESS
______________________________________________________________
______________________________________________________________
PHONES
______________________________________________________________
EMAIL
______________________________________________________________
EMPLOYER ______________________________________________________________
POSITION
______________________________________________________________
DEGREES
______________________________________________________________
OTHER LEADERSHIP EXPERIENCE (board, professional and/or community involvement)
______________________________________________________________
______________________________________________________________
______________________________________________________________
QUALIFICATION STATEMENT- PLEASE ATTACH (A brief description of skills, resources and
experience make you a qualified candidate for the Board - 50 – 100 words for ballot and website)
PLEASE ALSO PROVIDE:
 Résumé or CV
 Headshot photo (preferably professional for ballot and website)
 1 Professional reference - name and contact information
SUBMIT TO: Peggy Mallick
[email protected]
203-691-5013