CALIFORNIA SCHOOL NURSES ORGANIZATIONSCHOOL NURSES OPTIMIZE HEALTH AND ENHANCE LEARNING

EXCELLENCE IN SCHOOL NURSING ADMINISTRATOR APPLICATION

PURPOSETo publicly recognize and annually honor California school nurse administrators who leads, manages, and coordinators quality school nursing services and school health programs.

DUE –NOVEMBER 1All applications must be submitted on the CSNO Website under awards section for State consideration by December 15. Southern Section Awardees must submit their application by November 1.

Nominee must be: 1. A credentialed school nurse.2. A member in good standing of CSNO for the preceding two years (to advance as a NASN

Candidate, you must be a NASN Member in Good Standing for the past two years with no lapse in membership.)

3. Completed five years in school health experience, currently practice full-time and have as their main responsibility the supervision, administration, and coordination of nursing service and health programs

4. Evidence of excellence in school nursing administration based on Scope and Standards for Nurse Administrators, 3rd Ed (American Nurses Association).

  Procedure for Submission of Application*1. Provide a 1-2 paragraph bio, which will be used in the CSNO State Bulletin.2. Provide a high resolution digital photo, which will be used in the CSNO State Bulletin.3. Provide a 300 word summary of accomplishments as a school nurse/health services

administrator grounded in School Nursing: Scope and Standards of Professional School Nursing Administration, 3rd Ed*. The Scope and Standards include:

Employs the nursing process on an organizational level;o Assessment, identifies issues/trends, outcomes identification, planning,

implementation, coordination and evaluation; Fosters health promotion, health teaching, and education; Provides consultation; Promotes quality of practice and professional practice evaluation; Conducts research; Participates in ethical standards of practice and demonstrates integrity; Champions collegiality and collaboration; Optimizes and leverages resource utilization; Cultivates leadership; and Progressively advocates for school nursing/school health services.

**Upon submission of all applications and depending on the quality of applications, the CSNO State Board reserves the right to select one section nominee to represent California in the NASN State Affiliate Award. It is recommended that all candidates develop a portfolio of the above contents to be submitted to NASN. California representative from CSNO to advance to NASN, must be an NASN member in good standing for the past two prior years, with no lapse in membership.

CALIFORNIA SCHOOL NURSES ORGANIZATIONSCHOOL NURSES OPTIMIZE HEALTH AND ENHANCE LEARNING

Name of Nominee and Credentials ______________________________________Nominee's Home Address _____________________________________________City, State and Zip Code______________________________________________Phone Number (H)___________________ (W) ____________________________Cell ______________________________E-mail___________________________

Employer __________________________________________________________Address ___________________________________________________________Supervisor & Title___________________________________________________ Superintendent______________________________________________________Phone_____________________________________________________________Address____________________________________________________________

Present Position _____________________________________________________Number of years in position ___________________________________________Position Full Time YES ___ NO ___Supervisor of health? Or School health administrator? YES ___ NO ___Member of CSNO/NASN, current and preceding years YES ___ NO ___

Please sign and date below

I, ____________________________________, certify that the information in this document is accurate and that I am an active member of CSNO. It is my understanding that if any part of this application is incorrect it could jeopardize my participation in the State and National Recognition for the School Nurse of the Year. Additionally, if I am selected as the California representative for CSNO to advance to NASN, I must be an NASN member in good standing for the past two prior years, with no lapse in membership.

Date Signature