SIGMA THETA TAU INTERNATIONAL - School of Nursing



HONOR SOCIETY OF NURSING SIGMA THETA TAU INTERNATIONAL Nurse Leader Membership ApplicationPLEASE READ CAREFULLY:Thank you for your interest in the Honor Society of Nursing, Sigma Theta Tau International membership. This application can only be submitted if you are currently NOT enrolled in a nursing degree program at an institution of higher learning where a chapter is located, you hold a Baccalaureate Degree or equivalent, have not been previously inducted into the honor society and are legally recognized to practice nursing in your country.Instructions: Complete this required information for consideration for membership in SigmaTheta Tau International. Personal InformationName2001520-254000(Name and Credentials)200152018478500HomeAddress(Number and Street)20015202095500(City/Province, State, Postal Code, Country)200152018669000BusinessAddress(Employer Name/Department)20015202095500(Number and Street)2001520-13271500TelephoneNumbers(City/Province, State, Postal Code, Country)2001520-254000(Office)(Home)200152018478500Fax NumberBusiness211582016510000E-mail addressHomeE-mail address Should STTI use your “business” or “home” e-mail address for communication? Preferred Sigma ThetaTau Chapter (if known)Gamma Kappa, University at Buffalo School of Nursing8915402730500Nurse Leader Application – Page 28915405092700089154083947000Present Position (title and description)891540-47180500891540-14097000Education (include basic preparation through highest degree held)DegreeInstitutionMajor AreaYear(Name, City, Country)Of StudyCompleted1. 1376680-158115001376680184785002.1376680-162560001376680186690001367155529590003.Use the space below to briefly describe your professional experience or areas of expertise which name your achievements in nursing. (You may use bullet points to highlight your career).Please return (fax, email, mail) to: Dr. Janice JonesSTTI, Gamma Kappa Governance ChairUniversity at BuffaloSchool of Nursing222 Wende HallBuffalo, NY 14214 716-829-2304 (office)716-829-2021 (fax)jsylakow@buffalo.edu ................
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