COUNCIL ELECTION COUNCIL NOMINATION FORM

INFORMATION REQUIRED FOR LPNS SEEKING TO BE NOMINATED TO COUNCIL

LPNs seeking election as a District Council Member need to follow the outline below for successful submission. Please print this document and go through each of the Check Boxes to ensure that you have all the items to submit your nomination package.

CHECK BOXES:

 Completion of the nomination form in full.  Completion of the candidate profile in full. o Your candidate profile will be shared with all voters in your Election District. You should carefully consider your answers in the profile to reflect your commitment to the role as a District Council Member and the mandate of the CLPNA, which is protection of the public.  Good quality head and shoulders picture of yourself (passport type/head shot), preferably a digital picture emailed to [email protected].  One (1) minute video, where you have the opportunity to let LPN voters know why you are the best candidate seeking election to Council in your district. o The CLPNA website page will have your video first and then the information that you provided with your nomination supplemental to that. Email to [email protected].  Instructions on How to Submit your Video see Appendix “A.”  CLPNA Photo/Video Release Policy see Appendix “B.”  For an alphabetical listing of cities within each election district see Appendix “C.”

Please Note – The candidate profile and photo along with the video will be used electronically in the election information that is distributed to all members in the district you are seeking nomination from.

PLEASE SUBMIT ALL ELEMENTS OF THE NOMINATION PACKAGE TO:

Please submit your completed nomination form, candidate profile and digital picture electronically to [email protected] by the deadline of May 31st. See Appendix A for instructions on how to submit your video electronically. If you require assistance in this, please contact Marge Malenfant directly at the CLPNA for assistance via email at [email protected] or telephone 780-638-6716.

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ELECTION INFORMATION FOR DISTRICT COUNCIL MEMBERS

TERMS

The terms of office of each member of Council is for three (3) years starting on September 1 of the year of his/her election and may be renewed once. The term of office of each member of Council in office expires on August 31 in the Third year following the year of his/her election.

ELECTION YEAR DISTRICTS UP FOR ELECTION DISTRICT 1: SOUTH () 2019 – 3 YEAR TERM DISTRICT 3: SOUTH CENTRAL (RED DEER & AREA) DISTRICT 5: NORTH CENTRAL

SEE APPENDIX “C” FOR AN ALPHABETICAL LISTING OF CITIES WITHIN CLPNA ELECTIONS DISTRICTS

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CLPNA DISTRICT COUNCIL MEMBER NOMINATION FORM

NOMINATOR’S INFORMATION We, the undersigned LPNs, support the nomination of ______(printed name of nominee) for the position District Council Member for District #_____.

PRINTED LPN NAMES REGISTRATION #`S EXPIRY DATES SIGNATURES

1.

2.

3.

4.

5.

NOMINEE INFORMATION I understand the nature of the position of Council Representative and consent to having my name included on the election ballot for District #______.

NAME (PLEASE PRINT) SIGNATURE

MAILING ADDRESS CITY POSTAL CODE

E-MAIL REGISTRATION # EXPIRY DATE

TELEPHONE # CELL #

Serving on Council requires a significant amount of time to prepare for and attend meetings, committee work, preparation, ownership linkage, board education, and initial orientation. The time commitment expected from a Council member is as follows; ½ day initial orientation, one-two days governance education, ½ day prep work for each meeting, one - two day meetings quarterly to review reports of College business and plan upcoming goals, two days annually as host of the AGM and annual conference and one day as host for the annual Think Tank for a total of 13 days attendance per year plus other meetings as needed. Travel expenses and honorarium for meeting attendance is supported.

Are you able and prepared to commit to the time?  Yes  No

A computer is provided to Council members, are you reasonably proficient with email and downloading documents?  Yes  No

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CLPNA COUNCIL ELECTION CANDIDATE PROFILE

NOMINEE INFORMATION

NAME: ______DISTRICT: ______

1. Educational Background: include year of graduation, educational preparation, nursing or other. (i.e. 2000 PN, YXZ College; 2005 Business Administration, ZXY College)

PROGRAM NAME EDUCATIONAL INSTITUITION YEAR COMPLETED

2. Employment Background: list nursing-related employment, starting with your present employment up to 10 years (i.e. 2001-current, Lactose Consultant, XYZ Hospital; 2001 – 1995, Staff Nurse, ZXY Clinic)

EMPLOYER JOB TITLE YEAR(S) XXXX - XXXX

3. List any professional groups you may have been involved with including involvement with CLPNA, volunteering, charities, board positions, etc. (i.e. 1999 member, Steering Committee, YXC Hospital)

ORGANIZATION GROUP NAME DESCRIPTION OF INVOLVEMENT YEAR(S) XXXX - XXXX

4. Community Activities: list any community activities you are involved in. (i.e. 2013 Volunteer, Red Cross)

ORGANIZATION GROUP NAME DESCRIPTION OF INVOLVEMENT YEAR(S) XXXX - XXXX

5. What are the top three reasons that you would like to join Council that align with the CLPNAs Mandate of “To lead and regulate the profession in a manner that protects and serves the public through excellence in practical nursing.”?   

6. What knowledge, experience or attributes do you bring to the position?  

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APPENDIX “A”

Instructions on How to Submit your Video

How to Submit Video: Save the video on your phone, camera or laptop. You will not be able to send this large file directly by email; the CLPNA will email you with a secure link after you have emailed your completed nomination form to Marjorie Malenfant at [email protected].

Advice on Video Production: We recommend that you use a well-lit area for filming, and be close enough to the microphone to capture good audio.

Let your face fill most of the frame (horizontally), like this: We DO NOT RECOMMEND vertically filmed videos as in the below example:

Look into the camera lens while speaking. Ensure the camera is slightly above eye level, neither too far below your chin (looking up your nose) or above your eyes (looking down on the top of your head).

Here is some information that will help you create your video:

The Council’s responsibilities include:  The Council is responsible for the overall direction of the CLPNA and, through Policy Governance, is responsible for: setting CLPNA strategic direction including Mission, Vision, Mandate and Outcomes. Setting Bylaws, Regulations, Standards of Practice, and Code of Ethics (see Legislation, Practice & Policy on CLPNA website).  Approving practical nurse education programs and reviewing annual financial statements.  The Council does not manage the day-to-day operations of the CLPNA, which is administered by the Chief Executive Officer and staff.

Some ideas about what characteristics an elected Council member requires are:  Characteristics of a successful Council Member include, making difficult unified decisions that follow the CLPNA’s Mandate This may mean making decisions that does not promote the profession of practical nursing, but for public protection.  Critical and future thinking, servant leader that has the willingness to understand many perspectives and implications of decisions of the Council.  Active participant who is articulate and willing to debate in a constructive and respectful manner.  Commitment to devote time for meeting preparation, additional learning, and to attend all required meetings.  Click here for more information about Council, the role, characteristics of Council members.

Further Help?

If you need further help with this you can also contact myself at 780-638-6716 or email me at [email protected].

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APPENDIX “B”

CLPNA Photo/Video Release Policy

As a not-for-profit organization that regulates the profession of practical nursing, the College of LPNs of (CLPNA) often uses practical nurse photographic and electronic images of workplace settings, events, ceremonies and other activities to advance the mission of the organization.

LPNs, students, educators, staff members, and health professionals related to and associated with the activities of LPNs and the CLPNA may be identified or photographed for publication, broadcast, transmission and/or electronic display by the CLPNA. The photographs may also be made available to regional, provincial, national and international news agencies and media outlets. The images are not published for commercial purposes and do not violate the privacy of any individual or group.

By having a loose or formal relationship with the CLPNA directly by membership or indirectly by association in a work setting, photography subject(s) authorize the use and reproduction by the CLPNA, or anyone authorized by the CLPNA, to any photographs taken, without compensation. All negatives and positives, photographic prints and digital photo files shall constitute CLPNA property, solely and completely.

Photo/Video Release Form

For valuable consideration received, I hereby authorize the College of Licensed Practical Nurses (CLPNA), and those acting pursuant to its authority, the irrevocable and unrestricted right to use and publish photographs of me, or in which I may be included, for editorial trade, advertising, and any other purpose and in any manner and medium; and to alter the same without restriction.

I hereby release the College of Licensed Practical Nurses and those acting pursuant to its authority from all claims and liabilities relating to said photographs.

All photos will remain the property of the College of Licensed Practical Nurses of Alberta.

Name: (printed) ______

Phone Number: ______

E-mail: ______

Signature: ______

Date: ______

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APPENDIX “C”

ALBERTA CITIES AND CLPNA ELECTION DISTRICTS

Town/City District Town/City District District 7 – North Blairmore District 1 – South District 1 – South Blue Ridge District 7 – North Acheson District 4 – Blueberry Mountain District 6 – North West Acme District 3 – South Central Bluesky District 6 – North West Airdrie District 2 – Bluffton District 3 – South Beach District 3 – South Central Bon Accord District 4 – Edmonton District 4 – Edmonton Bonnyville District 5 – North Central Alhambra District 3 – South Central Botha District 3 – South Central Alix District 3 – South Central Bow Island District 1 – South Amisk District 3 – South Central Bowden District 3 – South Central Andrew District 3 – South Central Boyle District 5 – North Central Anzac District 7 – North Boyne Lake District 7 – North Ardmore District 5 – North Central District 2 – Calgary Ardrossan District 4 – Edmonton Brant District 3 – South Central District 3 – South Central Breton District 3 – South Central Athabasca District 5 – North Central Brooks District 1 – South District 7 – North Brownfield District 3 – South Central Atmore District 5 – North Central District 6 – North West Banff District 2 – Calgary Bruce District 3 – South Central Barnwell District 1 – South District 3 – South Central Barons District 1 – South Buffalo District 1 – South Barrhead District 5 – North Central Burdett District 1 – South Bashaw District 3 – South Central Busby District 5 – North Central Bassano District 1 – South Cadogan District 3 – South Central District 3 – South Central District 4 – Edmonton Beaumont District 4 – Edmonton Calgary District 2 – Calgary Beaver County District 5 – North Central Calmar District 4 – Edmonton Beaverlodge District 6 – North West Camp Creek District 5 – North Central Beiseker District 2 – Calgary Camrose District 3 – South Central Bellevue District 1 – South Canmore District 2 – Calgary Bellis District 5 – North Central Canyon Creek District 5 – North Central Bentley District 3 – South Central Carbon District 3 – South Central Berwyn District 6 – North West District 1 – South District 3 – South Central Caroline District 3 – South Central Black Diamond District 2 – Calgary District 2 – Calgary Blackfalds District 3 – South Central Carstairs District 3 – South Central Blackfoot District 3 – South Central Carvel District 4 – Edmonton Blackie District 2 – Calgary District 5 – North Central

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Town/City District Town/City District Castor District 3 – South Central Delia District 3 – South Central Cayley District 2 – Calgary Denwood District 3 – South Central Cereal District 1 – South Derwent District 3 – South Central Champion District 2 – Calgary District 1 – South Chauvin District 3 – South Central Devon District 4 – Edmonton Cherhill District 5 – North Central Diamond City District 1 – South Cherry Grove District 5 – North Central Dickson District 3 – South Central District 2 – Calgary Didsbury District 2 – Calgary Chipman District 3 – South Central Dixonville District 6 – North West Clairmont District 6 – North West Donalda District 3 – South Central District 3 – South Central Donnelly District 6 – North West Claresholm District 2 – Calgary District 3 – South Central Clive District 3 – South Central Driftpile District 6 – North West Cluny District 2 – Calgary Drumheller District 3 – South Central Clyde District 5 – North Central Duchess District 1 – South Coaldale District 1 – South Duffield District 4 – Edmonton Coalhurst District 1 – South Dunmore District 1 – South Cochrane District 2 – Calgary Eaglesham District 6 – North West Cold Lake District 5 – North Central Eckville District 3 – South Central Coleman District 1 – South Edberg District 3 – South Central Colinton District 5 – North Central Edgerton District 3 – South Central Compeer District 3 – South Central Edmonton District 4 – Edmonton Condor District 3 – South Central Edson District 5 – North Central Consort District 3 – South Central Elk Point District 5 – North Central Coronation District 3 – South Central Elnora District 3 – South Central County #1 District 6 – North West Empress District 1 – South County of Barrhead District 7 – North District 4 – Edmonton Coutts District 1 – South Enoch District 4 – Edmonton Cowley District 1 – South Entwistle District 4 – Edmonton Craigmyle District 3 – South Central Erskine District 3 – South Central Cremona District 2 – Calgary Evansburg District 4 – Edmonton Crooked Creek District 6 – North West District 2 – Calgary Crossfield District 2 – Calgary Fairview District 6 – North West District 1 – South Falher District 6 – North West Czar District 3 – South Central Fallis District 4 – Edmonton District 5 – North Central Ferintosh District 3 – South Central Darwell District 5 – North Central Flatbush District 5 – North Central District 3 – South Central Foisy District 7 – North De Winton District 2 – Calgary Foothills District 3 – South Central Debolt District 6 – North West Foremost District 1 – South Delacour District 2 – Calgary Forestburg District 3 – South Central Delburne District 3 – South Central District 5 – North Central

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Town/City District Town/City District District 7 – North Innisfail District 3 – South Central Fort Kent District 5 – North Central Innisfree District 3 – South Central Fort Macleod District 1 – South Irma District 3 – South Central Fort McMurray District 7 – North Iron Springs District 1 – South District 4 – Edmonton Irricana District 2 – Calgary District 7 – North Irvine District 1 – South Fox Creek District 6 – North West Island Lake District 5 – North Central Frog Lake District 5 – North Central Islay District 3 – South Central Gadsby District 3 – South Central James River Bridge District 4 – Edmonton Gainford District 4 – Edmonton Jarvie District 5 – North Central Galahad District 3 – South Central Jasper District 5 – North Central Gibbons District 4 – Edmonton Jenner District 2 – Calgary Gift Lake District 6 – North West District 7 – North Girouxville District 6 – North West Kananaskis District 3 – South Central Glendon District 5 – North Central District 2 – Calgary District 6 – North West Kehewin District 5 – North Central Grande Prairie District 6 – North West Kelsey District 3 – South Central Granum District 1 – South Keoma District 2 – Calgary Grassland District 5 – North Central Killam District 3 – South Central Grassy Lake District 1 – South Kingman District 3 – South Central Grimshaw District 6 – North West District 6 – North West Grovedale District 6 – North West District 3 – South Central Gunn District 5 – North Central District 7 – North Guy District 6 – North West District 6 – North West Gwynne District 3 – South Central Lac Des Arcs District 3 – South Central Halkirk District 3 – South Central Lac La Biche District 5 – North Central Hanna District 3 – South Central Lacombe District 3 – South Central District 3 – South Central District 3 – South Central District 2 – Calgary LaCorey District 7 – North District 3 – South Central Lake Louise District 1 – South Heisler District 3 – South Central District 1 – South District 3 – South Central Lamont District 3 – South Central High Level District 7 – North Lancaster Park District 4 – Edmonton High Prairie District 6 – North West Langdon District 2 – Calgary High River District 2 – Calgary District 3 – South Central Hillcrest Mines District 1 – South Leduc District 4 – Edmonton Hinton District 5 – North Central District 4 – Edmonton Holden District 3 – South Central Legal District 4 – Edmonton Hondo District 5 – North Central Leslieville District 3 – South Central Huxley District 3 – South Central Lethbridge District 1 – South District 5 – North Central District 1 – South Hythe District 6 – North West Linden District 3 – South Central

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Town/City District Town/City District District 3 – South Central Onoway District 5 – North Central Lone Pine District 5 – North Central Opal District 5 – North Central Lougheed District 3 – South Central Owlseye District 5 – North Central District 3 – South Central Owlseye District 7 – North District 1 – South Oyen District 1 – South District 2 – Calgary Paddle Prairie District 7 – North Madden District 2 – Calgary Parkland District 3 – South Central Magrath District 1 – South District 4 – Edmonton Manning District 6 – North West Peace River District 6 – North West Mannville District 3 – South Central Peerless Lake District 5 – North Central District 2 – Calgary Penhold District 3 – South Central District 3 – South Central District 5 – North Central District 3 – South Central District 5 – North Central Mayerthorpe District 5 – North Central Picture Butte District 1 – South Mclennan District 6 – North West Pincher Creek District 1 – South District 1 – South Plamondon District 5 – North Central District 3 – South Central Ponoka District 3 – South Central Milk River District 1 – South District 3 – South Central District 2 – Calgary Priddis District 2 – Calgary Millet District 3 – South Central Provost District 3 – South Central Minburn District 4 – Edmonton District 1 – South Mirror District 3 – South Central Radway District 5 – North Central Monarch District 1 – South Rainbow Lake District 7 – North District 4 – Edmonton Rainier District 1 – South Morrin District 3 – South Central Ranfurly District 3 – South Central District 2 – Calgary Raymond District 1 – South Mountain View District 1 – South Red Deer District 3 – South Central District 3 – South Central District 3 – South Central District 3 – South Central District 5 – North Central Nampa District 6 – North West Redcliff District 1 – South Nanton District 2 – Calgary Redwater District 4 – Edmonton District 5 – North Central Redwood Meadows District 2 – Calgary District 7 – North Rimbey District 3 – South Central Nevis District 3 – South Central Rivercourse District 5 – North Central District 3 – South Central Robb District 5 – North Central District 4 – Edmonton District 3 – South Central District 5 – North Central District 3 – South Central District 7 – North Rocky View District 3 – South Central Nobleford District 1 – South District 3 – South Central District 3 – South Central Rockyford District 2 – Calgary Okotoks District 2 – Calgary Rockyview County District 2 – Calgary Olds District 3 – South Central Rolling Hills District 1 – South

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Town/City District Town/City District Rosalind District 3 – South Central District 4 – Edmonton Rosedale Station District 1 – South Strathmore District 2 – Calgary Rosemary District 1 – South Strome District 3 – South Central Round Hill District 3 – South Central District 4 – Edmonton Rumsey District 3 – South Central Sundre District 3 – South Central Rycroft District 6 – North West Sunnybrook District 4 – Edmonton District 3 – South Central Sunset House District 6 – North West Saddle Lake District 5 – North Central Swan Hills District 5 – North Central District 5 – North Central Sylvan Lake District 3 – South Central District 4 – Edmonton Taber District 1 – South Sedalia District 1 – South Tangent District 6 – North West Sedgewick District 3 – South Central District 5 – North Central District 1 – South Tees District 3 – South Central Sexsmith District 6 – North West Thorhild District 5 – North Central Shaughnessy District 1 – South Thorsby District 4 – Edmonton District 4 – Edmonton Three Hills District 3 – South Central District 1 – South Tiger Lily District 7 – North Siksika District 2 – Calgary Tilley District 1 – South Slave Lake District 5 – North Central District 3 – South Central District 5 – North Central Tomahawk District 4 – Edmonton District 5 – North Central Torrington District 3 – South Central Spirit River District 6 – North West Trochu District 3 – South Central District 1 – South District 3 – South Central Spring Lake District 4 – Edmonton Turin District 1 – South Springbrook District 3 – South Central Turner Valley District 2 – Calgary District 4 – Edmonton Two Hills District 3 – South Central District 3 – South Central District 6 – North West Sputinow District 5 – North Central Valleyview District 6 – North West St. Albert District 4 – Edmonton Vauxhall District 1 – South St. Brides District 5 – North Central District 3 – South Central St. Isidore District 6 – North West Vermilion District 3 – South Central St. Lina District 5 – North Central Veteran District 3 – South Central St. Michael District 3 – South Central Viking District 3 – South Central St. Paul District 5 – North Central Vilna District 5 – North Central Stand Off District 1 – South Vimy District 5 – North Central Standard District 2 – Calgary Vulcan District 2 – Calgary Star District 3 – South Central Wabamun District 4 – Edmonton Stauffer District 3 – South Central Wabasca District 5 – North Central Stavely District 2 – Calgary Wainwright District 3 – South Central Stettler District 3 – South Central District 5 – North Central Stirling District 1 – South Warburg District 4 – Edmonton Stony Plain District 4 – Edmonton Wardlow District 1 – South

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Town/City District District 5 – North Central Water Valley District 3 – South Central Wembley District 6 – North West District 3 – South Central District 5 – North Central District 5 – North Central District 3 – South Central Whispering Hills District 7 - North Whitecourt District 5 – North Central Willingdon District 3 – South Central Wimborne District 3 – South Central Winfield District 3 – South Central Woking District 6 – North West District 3 – South Central District 4 – Edmonton

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