The National Collaborative for Transition to Practice (TNCTTP)
Request to Serve
We wish to express our sincere gratitude for your interest to serve. Please take a moment to complete this form.
OK
1.
Last name:
2.
First name:
3.
Credentials:
4.
Preferred email address:
5.
Preferred phone number:
6.
Employer name:
7.
Please identify which committee you are interested in sharing your talents with. Rank order your interest in serving, with 1 being high and 5 being low. If you have no interest in a committee, please enter 0. If you have no preference, please enter X under "no preference."
Ranking of preference
Research and Publications
-- Select an option --
1 - Highly interested
2 - Somewhat interested
3 - Neutral interest
4 - Somewhat uninterested
5 - Low interest
0 - No interest
X - No preference
Marketing and Communications
-- Select an option --
1 - Highly interested
2 - Somewhat interested
3 - Neutral interest
4 - Somewhat uninterested
5 - Low interest
0 - No interest
X - No preference
Philanthropy
-- Select an option --
1 - Highly interested
2 - Somewhat interested
3 - Neutral interest
4 - Somewhat uninterested
5 - Low interest
0 - No interest
X - No preference
Bylaws
-- Select an option --
1 - Highly interested
2 - Somewhat interested
3 - Neutral interest
4 - Somewhat uninterested
5 - Low interest
0 - No interest
X - No preference
Standards, Andragogy, and Guidelines
-- Select an option --
1 - Highly interested
2 - Somewhat interested
3 - Neutral interest
4 - Somewhat uninterested
5 - Low interest
0 - No interest
X - No preference
No preference
-- Select an option --
1 - Highly interested
2 - Somewhat interested
3 - Neutral interest
4 - Somewhat uninterested
5 - Low interest
0 - No interest
X - No preference
Comments:
8.
My interest and experience I bring to this group are:
(500 words or less)
