Application Item Writers Panel
Committed to Excellence; Passionate about Care
Recertification Audit and GI Specific Audit CommitteeApplication
The American Board of Certification for Gastroenterology Nurses is seeking volunteersto serve on ABCGN Committees. Qualified, highly motivated and professionally committed nurses are needed to assist in Recertification packet review and GI specific reviews. Contact hours will be awarded to committee members under Category 11. Please review the following qualifications for committee members prior to submitting your applications
REQUIREMENTS
- Maintain GI certification
- Have gone through at least one recertification process (not by testing)
- Currently employed in gastroenterology nursing
- SGNA membership preferred
- Be willing to serve a two-year commitment
- Attend a committee meeting held during the SGNA Annual Course and/or orientation session
- Access to computer
APPLICATION
Directions: Please type or print all the requested information. Return the form with your personal narrative to: or ABCGN Headquarters 330 North Wabash, Suite 2000, Chicago, IL 60611. Please indicate which committee you are interested in.
NAME:______
COMMITTEE PREFERENCE: Recertification GI Audit No preference
1. Have you attended an Item Writers Workshop? YesNo
(if yes, how many times?)______
- When did you last recertify? ______
- Credentials______
- Preferred Fax: ______Preferred e-mail______
- Present Title:______
- Present Employer: ______
- Setting for practice: (Select One)
Hospital Ambulatory Care Center Free Standing Endoscopy Center
Office Surgery Other (specify) ______
8. Past regional and/or national involvement ______
9. Areas of expertise and interest______
10. Please tell us why you feel you are qualified to be on this committee in 100 words or less.
______
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______
______
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Please submit additional pages if needed.
By submitting this form, I attest to the accuracy of the information provided. I understand that my committee assignment will be for a period of two years, and if selected, I will have to sign a confidentiality agreement.
Signature: ______
Date: ______