Hospital System you primarily work at (for educators or students, state the name of your school): *
Your answer
Department/Unit you primarily work at:
Your answer
Number of years in nursing:
Your answer
Number of years as a member of AACN:
Your answer
Number of years as a member of MOC:
Your answer
Number of years in critical care:
Your answer
Are you certified? *
If you are certified, how many years have you been certified?
Your answer
Highest nursing degree: *
Choose
LPN
Associate
BSN
Master - Education / Administration
Master - APRN
Master - Non-Nursing
Doctorate - DNP
Doctorate - PhD
Student Nurse
What do you expect from the MOC chapter?
Your answer
What do want from the MOC chapter that you don’t receive now?
Your answer
Is the monthly meeting day/time/locations meeting your needs? *
If "No" to the above question, please note below how the meeting day/time/locations could better meet your needs:
Your answer
Check the your TOP THREE preferred topics from those listed below: *
Required
Please indicate any other topics that you would consider important to cover in one of our upcoming MONTHLY MEETINGS:
Your answer
What type of speaker do you prefer at our monthly meetings? (Select all that apply) *
Required
If we offered a live webinar (streamed live via Zoom) during our monthly meetings would you be interested in ‘attending’ utilizing this method? *
If we offered a recording of an education session provided at our monthly meeting that can be seen on your own time (if permitted by the speaker), would you be interested in utilizing this method? *
If we plan our annual ONE conference again this Fall, what type of Continuing Education Program would you prefer to attend? *
Required
Please list topics you would consider important to cover in a SEMINAR in the coming year:
Your answer
What are your professional goals related to AACN certification? *
Required
Are you interested in being mentored into a board member position for next year?
Clear selection
Are you interested in participating on a MOC committee this upcoming year? *
If you answered "Yes" or "Maybe" to interest in "Board Member Position" or "MOC Committee," please write your name and a method of contact below:
Your answer
Please list an organization that you would be willing to volunteer/donate to this upcoming year?
Your answer
Would you be interested to attend a dedicated event towards professional networking, mentoring, and interactive dining?
Clear selection
How can MOC better engage with you via social media? What methods of communication do you prefer? What kind of information or posts do you want us to share on social media?