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| APPLICATION FOR STATE OFFICE This is to certify that _______________________________________ is a candidate for the office of ______________________________________. This candidate is a student in good standing at ___________________________________________________________ (school) and meets the qualification for this office. |
| __________________________________ Candidate __________________________________ GANS Chapter President __________________________________ Dean/GANS Advisor __________________________________ Date |
| BIOGRAPHICAL INFORMATION Name: _______________________________________________________ Mailing Address: _______________________________________________ City: __________________________ State: _____ ZIP: ____________ Phone: _______________________ Fax: __________________________ Email: ________________________________________________________ Date of Birth: ____________________ Martial Status: ________________ Name of School: _______________________________________________ Type of Program: ______________________________________________ GPA: ____________________________ Graduation Date: ___________ Year in School: Freshman Sophomore Junior Senior |
| GOALS OF OFFICE / REASONS FOR APPLYING: ACTIVITIES / HONORS: BACKGROUND INFORMATION: related to Nursing and/or GANS that will show leadership qualities and skills vital to the office you are seeking. (Include past and present employment, education, organization activities, or other information pertinent to the office you are seeking) |
| If elected, I agree to serve GANS to the best of my ability and I am aware of the time and effort that is demanded by the responsibilities outlined in the bylaws for the office which I am being nominated. To the best of my knowledge, all statements made on this applications are true. I also acknowledge receipt of an understand the guidelines for campaigning. |
| __________________________________ Signature |
| __________________________________ Date |
| TO BE COMPLETED BY THE DEAN / GANS ADVISOR: |
| Do you feel that this student is capable of carrying out the responsibilities of the office without adversely affecting his/her clinical and academic performance? (Please explain) Please list the reason(s) why you feel this student is qualified to serve this office. It is the considered opinion of the faculty that this students record of performance is satisfactory and the student will be able to devote the time and effort necessary to fulfill the duties of this office. |
__________________________________ Signature Dean / GANS Advisor __________________________________ School of Nursing __________________________________ Name of Candidate |
| Deadline for pre-slating is September 12, 2003. Please send applications to: Traci Steinhauser 1727 Country Park Way Lawrenceville, GA 30043 (770) 339-9182 [email protected] |