American - ABNN Certification
SCRN 2024-2027 Test Development Committee ApplicationFirst Name: FORMTEXT ???? ?Last Name: FORMTEXT ???? ?Employer: FORMTEXT ???? ?Position: FORMTEXT ???? ?Work Address: FORMTEXT ???? ?City: FORMTEXT ????? State: FORMTEXT ????? Zip: FORMTEXT ?????Work Telephone: FORMTEXT ???? ?Primary Email: FORMTEXT ???? ?Number of Years in Nursing: FORMTEXT ???? ?Number of Years in Stroke Nursing: FORMTEXT ???? ?Number of Years Certified as SCRN: FORMTEXT ???? ?Attestations: FORMCHECKBOX I am available to attend the 2-day in-person TDC meetings that are held in conjunction with the AANN Annual Conference each year. I can attend this year’s meeting in Salt Lake City, UT on March 15th-16th. FORMCHECKBOX I understand that as a member of the TDC, I am unable to take the exam for recertification if it is during my term. I also understand that I cannot be involved in SCRN preparation materials during my term and for 2 years after my term ends.Primary SCRN Content Specialty Area: FORMCHECKBOX Anatomy, Physiology, and Etiology of Stroke FORMCHECKBOX Hyperacute Care FORMCHECKBOX Acute Care FORMCHECKBOX Post-acute Care FORMCHECKBOX Primary and Secondary Preventative Care Credentials: FORMCHECKBOX APN FORMCHECKBOX APRN FORMCHECKBOX CCRN FORMCHECKBOX CMSRN FORMCHECKBOX CNRN FORMCHECKBOX CRNP FORMCHECKBOX FAAN FORMCHECKBOX FAHA FORMCHECKBOX FNP-C FORMCHECKBOX LPN FORMCHECKBOX NEA-BC FORMCHECKBOX Other: FORMTEXT ???? ?Primary Position: FORMCHECKBOX Administrator FORMCHECKBOX Advanced Practice Nurse FORMCHECKBOX Case Manager FORMCHECKBOX Clinical Educator FORMCHECKBOX Clinical Nurse Specialist FORMCHECKBOX Consultant FORMCHECKBOX Faculty FORMCHECKBOX Instructor FORMCHECKBOX Nurse Practitioner FORMCHECKBOX Researcher FORMCHECKBOX Staff Nurse FORMCHECKBOX Student FORMCHECKBOX Other: FORMTEXT ???? ?Highest Degree Earned: FORMCHECKBOX ADN FORMCHECKBOX BN FORMCHECKBOX BSN or equivalent FORMCHECKBOX DNP FORMCHECKBOX MEd FORMCHECKBOX MS FORMCHECKBOX MSN FORMCHECKBOX PhD FORMCHECKBOX PhD Nursing FORMCHECKBOX Other: FORMTEXT ???? ?Area of Expertise: FORMCHECKBOX Mixed Neuroscience FORMCHECKBOX Neurology FORMCHECKBOX Neurosurgery FORMCHECKBOX Research FORMCHECKBOX Other: FORMTEXT ???? ?Primary Patient Population: FORMCHECKBOX Adult FORMCHECKBOX Geriatrics FORMCHECKBOX Mixed FORMCHECKBOX Neonatal FORMCHECKBOX Pediatrics FORMCHECKBOX Other: FORMTEXT ???? ?Primary Specialty Area: FORMCHECKBOX Epilepsy FORMCHECKBOX Geriatrics FORMCHECKBOX Movement Disorders FORMCHECKBOX Neuromuscular FORMCHECKBOX Neuro-Oncology FORMCHECKBOX Neurotrauma FORMCHECKBOX Pediatrics FORMCHECKBOX Spine FORMCHECKBOX Stroke FORMCHECKBOX Other: FORMTEXT ???? ?Primary Responsibility: FORMCHECKBOX Administrator FORMCHECKBOX Clinical Care FORMCHECKBOX Industry/Commercial FORMCHECKBOX Instructor FORMCHECKBOX Consultant FORMCHECKBOX Medical-Surgical FORMCHECKBOX Outpatient FORMCHECKBOX Perioperative FORMCHECKBOX Research FORMCHECKBOX Other: FORMTEXT ???? ?Work Setting: FORMCHECKBOX Academic FORMCHECKBOX Ambulatory FORMCHECKBOX Community Hospital FORMCHECKBOX Consulting FORMCHECKBOX Industry FORMCHECKBOX Private Physician Practice FORMCHECKBOX Rehabilitation Facility FORMCHECKBOX Research Lab FORMCHECKBOX University/Teaching Hospital FORMCHECKBOX Other: FORMTEXT ???? ? ................
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