2018 COE Intent to Apply Application Form

Transcription

1 2018 COE Intent to Apply Application Form (untitled) This application is to show intent to pursue designation or CONTINUING designation as an NLN Center of Excellence in Nursing Education for schools, colleges, and institutions of nursing. This completed application and payment are due to the NLN by October 15, Please note that you may submit payment via credit card (over the phone) or by check. To save your progress on this form and return later, please click on the black bar at the top of your screen and enter your address. You will receive a special link via that will allow you to return to this form. If you have any problems, please call the Membership Department at When you click submit, a copy of this survey will automatically be sent to the dean or contact person. You can save this survey and return to it by clicking on the black bar at the top of your screen and entering your address. You will be sent a link that will allow you to return to the survey. Applications are due by October 15, Best, Erin Maylett NLN Recognition Program Manager (untitled) 1. Name of College/University/Institution: *

2 2. School, college, or institutional contact information: * Address: City: State/Province: NLN Agency Member number: School of Nursing website: 3. COE designation being pursued (check one): * Enhance student learning and professional development Promote the pedagogical expertise of faculty Advance the science of nursing education Promote the academic progression of nurses (untitled)

3 4. School, college, or institutional information: * Total number of faculty teaching in all nursing programs this fall: Number of full-time faculty: Faculty to student ratio for your school: Total number of student this fall (in all programs): Total number of graduates in preceding year (in all programs): 5. Location of your organization: * Rural Urban

4 6. Type of healthcare organization? * Acute Care Acute/psychiatric Ambulatory/outpatient Long-term care/in-patient Rehabilitation Facility Pediatric acute care Other; please describe Comments 7. Teaching/Research Status (check all that apply): * Teaching Non-teaching Research Non-research 8. Number of beds (institutions without beds, enter zero): * Acute Care: Long-term:

5 9. Nursing Demographics: * Number of PN FTEs: Number of RN FTEs: Percentage of RNs with ADN as the highest nursing degree: Percentage of RNs with Diploma as the highest nursing degree: Percentage of RNs with BSN as the highest nursing degree: Percentage of RNs with MSN as the highest nursing degree: Percentage of RNs with a nursing doctorate as the highest nursing degree: 10. Is this application for a new designation or a continuing designation? (Note: If your school or organization has been awarded a designation in the past and is now applying for a different designation, it is considered a continuing designation.) * New designation Continuing designation Other - Write In

6 11. As a continuing designation application, would you like a visit from a NLN COE consultant? (NOTE: If changing COE categories, a consultant visit is strongly recommended.) Yes No Other - Write In 12. Contact information for the dean/director/chairperson/head: * First Name: Last Name: Title: Credentials: Address: Phone Number:

7 13. Contact information for this application if different than the dean/director: First Name: Last Name: Title: Credentials: Address: Phone Number: 14. What types of nursing programs are offered at this school (check all that apply): * Practical nurse Associate Degree Diploma Baccalaureate Master's Doctoral

8 15. Is your school or institution in good standing with the board of nursing in your state? * yes no 16. Please upload a copy of your current accreditation certificate from CNEA, ACEN, or CCNE; or JCAHO, NCQA, or AOA. Browse Please indicate the body (bodies) that currently accredit each of the following programs offered by your school. Also indicate the year in which that program will be reviewed for continuing accreditation. Program Accrediting body Accredited until (what year?) Row 1 Row 2 Row 3 Row 4 Row 5 Row 6

9 18. How did you learn about the NLN Centers of Excellence program? Word of mouth NLN Member Update ( ) I know faculty at a school that has been designated as a Center of Excellence. NLN Education Summit NLN staff Other - Write In 19. What motivated you and your colleagues to engage in the process of seeking designation as an NLN Center of Excellence? (100 words) * 20. What benefits do you and your colleagues anticipate if you are named as an NLN Center of Excellence? (100 words)

10 21. How did you and your colleagues decide which category to choose in seeking this designation? (100 words) * 22. Give a brief overview of your school, college, or institution to provide context for the consultant who will visit your school. (300 words maximum) * 23. Give a brief overview of your nursing program to provide context for the consultant who will visit your school. (700 words maximum) *

11 24. Please give a brief overview of your organization to provide context for the adviser who will visit. (700 words maximum) * 25. For each criterion in the COE category you have selected to pursue, please provide a brief summary of the initiatives currently underway at your school. *

12 The cost of this initial application is $250. To pay by credit card, please copy and paste this URL into a web browser and navigate to the page: To pay by check, make check payable to the National League for Nursing. Mail check to Membership Director, National League for Nursing, 2600 Virginia Ave., NW, 8th Floor, Washington, D.C Your application will not be processed until payment is received. You will receive a notification /receipt immediately when your payment is received by the NLN. NOTE: Form and payment are due by October 15. (See 2018 Handbook for more information.) For questions, please contact the NLN membership department at the number listed above, or us at recognition@nln.org. Thank you! Thank You! Thank you for taking our survey. Your response is very important to us.