Delegate Selection Tool
Please document score in far right column and a total at the bottom.
Points are accumulated for activities from April 1, 2008- March 31, 2009
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ENA Involvement
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Points awarded
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My Score
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General Assembly Delegate at the last General Assembly
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10
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Attend State Council Meeting (Must have attended at least 2 mtg over past year)
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10 per meeting
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Attend local chapter meetings (write dates of meeting on back of form)
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5 per meeting
(Cap of 25 pts)
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State ENA Council Officer
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25
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Local ENA Chapter Officer
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15
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Chair an ENA Committee (National 25pts/State 20pts/Local 10pts)
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Serve as committee Member (National 15pts/State 10pts/Local 5pts)
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New members recruited to ENA in past year. (5 pts per member)
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Professional Development
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Current Certification in Emergency Nursing CEN: ______ CPEN:_____
CEN Course Director
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25
20
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Publish articles in JEN or other health care related publication (Copy attached or link to online article)
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25
15
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Conduct research in emergency nursing (Non job required) (Copy attached or link to online article)
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10
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Lecture in emergency nursing (Non job required) 5 points per presentation
List dates and topic on back of form
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Cap of 25 points
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TNCC (Course director 15pts/Instructor 10pts) Take credit for 1 course directed and/or one course taught during this time frame.
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Cap of 25 points
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ENPC (Course director 15pts/Instructor 10pts) Take credit for 1 course directed and/or one course taught during this time frame.
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Cap of 25 points
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ENCARE (Course director 15 points) Instructor 5 points per presentation
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Cap of 25 points
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For TNCC, ENPC and ENCARE list dates/topics on back of form
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Community Involvement (Non ENCARE sponsored)
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Present topics of education to the public i.e. Injury Prevention
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Consumer Awareness/ Legislative Issues? Other emergency related topics
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5 points per presentation List dates and topic on back of form
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Cap of 25 points
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Educational Involvement
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Attend Michigan State Annual Conference
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5
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Attend ENA Leadership Conference
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5
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Attend National Scientific Assembly
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5
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Attend other ENA sponsored program List name of program and date on back of form
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5
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Total Points
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Name__________________________________________ ENA Membership#_____________
Address______________________________________ City_________________ Zip________
Phone Number (_____)________________ Email address____________________________
Shirt Size___________ Misses’ XS (4), S (6-8), M (10-12), L (14-16), XL 18-20), Women’s 1X (16-18W), 2X (20-22W), 3X 24-26W) (Shirts may be furnished by the state council- if budget allows)
All Applications must be received by Marilyn Sprague by April 1, 2009
Marilyn Sprague
1925 W. Millbrook
Mt Pleasant, MI 48858
barney@power-net.net
