2018 CSGNA Chapter of the Year Award Application

Fill in application year:

Application for year May 1st, *
to March 31st, *
Application must be received by May 30th, 2018.
Chapter Name:*
Chapter Executive: *
Position:*
Chapter Contact E-mail:*

Section 1: Membership

Number of Chapter members at July 1st of previous year: *

CSGNA Executive Assistant will provide final Chapter numbers as of May 30th, along with the new/renewing ratio. These do not need to be added to this form at time of application.

Section 2: Chapter Support

Was a Chapter Newsletter provided to members for Chapter news? *
Please attach an electronic copy of each newsletter to this application .
Was a workshop or study group developed for CNA Certification support?*
If so, how was this support provided?
Has the Chapter provided a method of feedback from its membership?*
If so, how was this done?

Section 3: Chapter Education

Fill in the educational events provided by the Chapter during the year.
Event 1
Date:
Topic:
Education Hours Provided:
Event 2
Date:
Topic:
Education Hours Provided:

Section 4: Member Involvement

Has a Chapter member presented at a Chapter meeting? *
If yes, please provide details: .
Has a Chapter member presented at the National Conference?*
If yes, please provide details:
Has a Chapter member provided an article for The Guiding Light? *
If yes, please provide details:
Have any Chapter members applied for a role at the National Level? *
If yes, please provide details:
Chapter members returned ballots for National Election and Bylaws*
(The President-Elect will provide the above number.)

Section 5: Member Chapter Growth

Please list the innovative ways your Chapter has attracted new members:*