Application to Run for 2027 NYSENA Officer and Board Member at Large

Deadline - May 30, 2026

* Indicates a Required Field

Name:*

Credentials (License, Degrees, Certifications):

Date:*

Address:*

City:*

State:*

Zip Code:*

Cell Phone:*

Email Address:* (do not use work email)

Employment Title:

ENA Membership Number:*

NYS License #:*

Board position sought:*

List the ENA activities you have participated in to support your application:*
(may be on state, regional, or national level) ie representative/alt, committees, educator.

Past Organizational / Leadership Experience (ENA preferred; Other):*

Reasons running for this position:* (150 words or less)

Eligibility Criteria:

NYS RN license
Member of NYSCENA for past 2 years
Attendance at minimum 2 of NYSCENA Council meetings in last 12 months
Attendance at 1 General Assembly (GA) in past 3 years &/or attendance at Setting the Pace (NYSCENA conference)

Photo requirements:

Need either .jpg or .png format.
Professional digital portrait headshot photograph
- Taken within the past three years
- NO AI generated photographs
- Professional business attire (no uniforms, scrubs, t-shirts, state council specific attire, etc.)
- At least 5” x 7” or 1500 x 2100 px
- High resolution (minimum of 300 DPI)
- File size must be less than 7MB

We recommend you submit the requirements above to a professional photographer to ensure your photo meets the required specs.

Photo: * (File size must be less than 7MB)

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Attestation Statement

Please read the Bylaws regarding the election rules.

Bylaws 2024

Please complete the

Financial Disclosure Form

Please mark each statement once completed.

I have read the NYSCENA Bylaws, Policies & Procedures. (Your Initials) *

I am committed to fulfilling the duties of the position for which I am applying. (Your Initials) *

I have completed the online Financial Disclosure form (Your Initials) *

Revised 2026

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Application to Run for Officer and Board Member at Large