Board Nominations Form

CPCNA Board of Directors Nomination Form

In preparation for our Annual General Meeting (AGM) the CPCNA is seeking volunteers interested in holding an elected position on the CPCNA Board of Directors. This is an excellent opportunity to support palliative care nursing across Canada, develop and demonstrate leadership skills and contribute to the success of your organization!

For 2024-2026 we are seeking nominations for Members to participate in the following roles

President-Elect (2 year term; followed by 2 years as President, 1-2 year Past-President) Description pending.
Director of Communications (2 year term)

Please complete each section of the nomination form below.

The nominee MUST agree to be nominated.
The nominee MUST be a CPCNA member.
The nominator MUST be a nurse regulated in Canada (CPCNA membership not required).
- If the nominator is not a Member of CPCNA, an additional Letter of Support will be required.
The nominee MUST meet the criteria for directorship in the CPCNA bylaws and role description in order to be eligible.

Please complete the form below and email Nomination Letters, Letters of Support (if indicated) and a photo to cpcnainfo@gmail.com.

Nominee Information (information collected is used in accordance with the CPCNA privacy policy posted at www.cpcna.ca. For the purpose of this application, information will be only shared with the CPCNA Board.

CPCNA Board Nomination Form

A. Nominee Information

First Name

Last Name

Credentials (i.e. education, certifications)

Position

Employer

Province/ Territory of Practice

Primary Phone

I confirm that the nominee is aware of and consents to being nominated for this position on the Board of Directors

B. Nominator Information

First Name

Last Name

Credentials (i.e. education, certifications)

Position

Employer

Relationship to nominee

Province/ Territory of Practice

Primary Phone

As a Nominator, I understand that if I am NOT a member of CPCNA, I must go to section D below and and additional Letter of Support is required.

C. Nominee biography and reason for seeking position on the Board

(250 words or less).

Please submit a Word or PDF document to cpcnainfo@gmail.com

D. Letter of Support from Nominator for the Nominee (250 words or less).

NOTE: This section needs only to be competed if the NOMINATOR is not a member of CPCNA. Should include:

writer relationship to nominee
discuss how the nominee can support the Mission, Purpose and Vision of CPCNA
discuss what skills the nominee will bring to the Board

Please submit a Word or PDF document to cpcnainfo@gmail.com

E. Nominee’s Photograph

Website does not support photo uploads.

Please submit a photo to cpcnainfo@gmail.com

To be less than 500 kb, in jpg, png or gif format).

Click the following to confirm:

By submitting this form, you are stating that all information is accurate.

By submitting this form, your signature is an endorsement of the nominee and you confirm there is no reason this Member should not be considered for a position on the Board.

In lieu of submitting a PDF signature, all materials submitted are consdeired to be signed by the nominee electronically.

As a nominee, I understand I need to email a photograph to cpcnainfo@gmail.com.

Thank you for submitting this Board Nomination!