RSVP 4 — Sussex County School Nurses Association

2020 - 2021 Application

“Burlington County School Nurse of the Year” Application

Name

First Name

Last Name

Phone

(###)

###

####

Address

Nursing Education

CURRENT EMPLOYMENT

District

School Building

Work Phone

(###)

###

####

Work E-mail

Population Cared For

WORK EXPERIENCE

How many years employed as a NJDOE-CSN?

How many years as an active member of BCSNA?

How many years as an active member of NJSSNA/NASN?

(You must be a current member.)

Professional Affiliations

Nominated By

(May include a brief letter written by the individual who nominated you, if applicable.)

First Name

Last Name

Please list a brief example of your performance related to at least THREE of the Standards of Professional School Nurse Practice.

Standards of School Nursing Practice: - Assessment - Diagnosis - Outcomes Identification - Planning - Implementation - Evaluation

Please list a brief example of your performance related to at least THREE of the Standards of Professional Performance in School Nursing. (National Association of School Nurses and American Nurses Association.)

Standards of Professional Performance in School Nursing: - Ethics - Education - Evidence-based Practice - Quality of Practice - Communication - Leadership - Collaboration - Professional Practice Evaluation - Resource Utilization - Environmental Health - Program Management