CALIFORNIA SCHOOL NURSES ORGANIZATIONSCHOOL NURSES OPTIMIZE HEALTH AND ENHANCE LEARNING

EXCELLENCE IN SCHOOL NURSING APPLICATIONPURPOSETo publicly recognize and annually honor California school nurses who demonstrate excellence in school nursing practice and leadership in school health.

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. A school nurse that has practiced at least five years within school nursing.4. A currently practicing school nurse of at least 50%. *If the only school nurse position in a

community involves fewer hours than usual, it will be considered for the purpose of this eligibility criteria.

5. Evidence of excellence in school nursing practice should be based on School Nursing: Scope and Standards of Practice 2nd Edition, 2011.

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 that address one or all

of the Scope and Standards of Professional School Nursing Practice. The Standards include: identifies and implements evidence-based practice and research; fosters student, staff or school community education; provides quality in your practice; conducts professional practice e evaluation; encourages communication; champions collaboration; maximizes resource utilization; models leadership; provides oversight for program management; ensures ethical standards and practice; and/or promotes public/environmental health.

All submissions for State Excellence in School Nursing must be submitted electronically on the CSNO Website. 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.

The California Representative Committee shall be chaired by the State PR chair, the NASN director, and CSNO President-Elect. The committee will oversee the process of selecting a State an awardee to NASN.

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 ___________________________________________Grade levels supervised in position______________________________________Number of students served_____________________________________________Position Full Time YES ___ NO ___Provider of direct nursing care in practice YES ___ NO ___(Indicate what % _________)Member of CSNO 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