IL State Council Delegate Application to the EN2024 General Assembly

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Submission Deadline: May 1, 2024

General Assembly Dates: September 3-4, 2024

General Assembly Location: Las Vegas NV

Please fill out your responses to the questions below. Each response is assigned a point which will be calculated as total points/score. Delegates will be chosen based on points earned through involvement with and participation in national ENA and IL State Council activities.

Prospective delegates to the General Assembly will be notified by mid June 2024.

Email *

Full Name: *

ENA Member Number:

Membership may NOT expire prior to the conclusion of the EN24 General Assembly (response will be verified):

Home Address (including zip code):

Home address will be used for mailing of documents pertaining to the General Assembly (if needed).

Cellphone Number:

This will be used for communications during the General Assembly.

How long have you been an ENA member (response will be verified)? *

1 to 5 years (1 point)

6 to 10 years (2 points)

11 to 15 years (3 points)

16 to 20 years (4 points)

Over 20 years (5 points)

ENPC and TNCC Certificates (must be current/ not expired) (responses will be verified):
*

ENPC Provider (1 point)

ENPC Instructor/Course Director (2 points)

TNCC Provider (1 Point)

TNCC Instructor/Course Director (2 Points)

I do not have these certificates

My certificates have expired

Required

BCEN Certifications (must be current/ not expired) (responses will be verified):
*

CEN (Certified Emergency Nurse) 2 points

CPEN (Certified Pediatric Emergency Nurse) 1 point

TCRN (Trauma Certified Registered Nurse) 1 point

CFRN (Certified Flight Registered Nurse) 1 point

CTRN (Certified Transport Registered Nurse) 1 point

CBRN (Certified Burn Registered Nurse) 1 point

I am currently not certified in any of the above specialties.

Required

I have attended the following ENA National Conferences in the past 3 years (responses will be verified): *

Emergency Nursing 2023 in San Diego, CA (1 point)

Emergency Nursing 2022 in Denver, CO (1 point)

Emergency Nursing 2021 - Virtual (1 Point)

I did not attend any of these

Required

I have attended the following IL ENA State Council Meetings (responses will be verified): *

February 18, 2023 (1 point)

May 20, 2023 (1 point)

August 19, 2023 (1 point)

November 18, 2023 (1 point)

I did not attend any of the meetings.

Required

I have attended the following IL ENA Spring Symposium in the past 3 years (responses will be verified): *

2023 Spring Symposium - Springfield (1 point)

2022 Spring Symposium - Lisle (1 point)

2019 Spring Symposium - Lisle (1 point)

I did not attend any of these

Required

In the past 10 years, how many times have you served as delegate to the General Assembly? *

I have not attended the General Assembly as a delegate

Scholarly work - Please select all that apply (responses will be verified): *

I was a POSTER PRESENTER at the IL ENA Spring Symposium (2019, 2022, &/or 2023) (1 point)

I was a PODIUM PRESENTER at IL ENA Spring Symposium (2019, 2022, &/or 2023) (1 point)

I was a POSTER PRESENTER at the ENA National Conference (2021, 2022, &/or 2023) (1 point)

I was a PODIUM PRESENTER at the ENA National Conference (2021, 2022, &/or 2023) (1 point)

I have PUBLISHED article(s) in the Journal of Emergency Nursing in the past 5 years (1 point)

I have REVIEWED article(s) for publication in the Journal of Emergency Nursing in the past 5 years (1 point)

I authored an ENA Position Statement or Topic Briefs in the past 5 years (1 point)

I have PUBLISHED my work about EMERGENCY NURSING in other nursing journals (1 point)

I did not do any of these in the past 5 years

Required

Volunteer work in the past 3 years - Please select all that apply (responses will be verified): *

I am/was a MEMBER of the ILLINOIS ENA committee/work team/advisory council/special interest group (1 point)

I am/was a CHAIRPERSON of the ILLINOIS ENA committee/work team/advisory council/special interest group (1 point)

I am/was a MEMBER of the ENA NATIONAL committee/work team/advisory council/special interest group (1 point)

I am/was a CHAIRPERSON of the ENA NATIONAL committee/work team/advisory council/special interest group (1 point)

I served as a FACULTY or workgroup MEMBER in an ILLINOIS ENA CEN Review Course in the past 3 years (1 point)

I participated in a Government Affairs activity in the past 3 years (IL Political Action Day or IL Nurses Day at the Capitol) (1 point)

I attended ENA Membership Promotion events in the past 3 years (HS Career Day, Job Fairs, or student conferences) (1 point)

I did not do any of these in the past 3 years

Required

I voted in the ENA Elections in the past year: *

ENA National Election (1 point)

IL ENA State Election (1 point)

I did not vote in the past year

Required

Involvement in IL ENA State Council: *

IL ENA Board of Directors

IL ENA Committee Chairperson/Co-chairperson

Archives Committee

Awards and Nominations Committee

Communications Committee

Education Committee

EMSC Committee

Evidenced-based Committee

Fundraising Committee

Government Affairs Committee

Quality, Safety, Injury Prevention Committee

Pediatric Committee

Spring Symposium Committee

Special Interest Group: SANE or Emerging Professional

I am not yet involved in any of the above committees

Required

I am interested in volunteering for the IL ENA State Council. *

Yes, please send me information

No, I'm not interested at this time

I am already a volunteer

If selected to serve as a delegate, will you be able to perform all delegate responsibilities and functions, including a delegate caucus on or before Day 2 of General Assembly and ATTEND ALL General Assembly sessions until released by the ENA President? *

Yes

If chosen, how will you utilize your experience as a delegate to the General Assembly to elevate the emergency nursing specialty in your institution and at the state level?
*

For first-time attendees ONLY:

What made you submit an application to be a delegate to represent the IL State Council to the General Assembly?

The August IL State Council meeting is reserved for the discussion of items such as bylaw changes and resolutions. Attendance to this meeting is MANDATORY and an in-person attendance is HIGHLY ENCOURAGED.

Are you able to attend the August 2024 State Council Meeting scheduled on Saturday, August 10, 2024 at the ENA Headquarters in Schaumburg, IL?

Yes, I will be attending in person.

A copy of your responses will be emailed to the address you provided.

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