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National Organization of Nurses with Disabilities (NOND) Member Registration
Greetings!
Welcome to the National Organization of Nurses with Disabilities! Thank you for your support and your membership application. Please fill out the following form. We will not share this information with anyone. Any questions that you do not want to answer, please feel free to skip that question. If you have any questions or concerns, please feel free to email us at NOND Info.
1) What is your name?
First Name Last Name
2) What is your job title?
Title
3) Where do you work?
Institution Name
4) Address?
Street Address City State Zip
5) What is your phone #?
Phone
6) What is your fax #?
Fax
7) What is your email address?
Email Address
8) Which of the following best describes your Membership Category(ies)? (check all that apply)
Pre-professional Student (e.g., nursing, medicine, PT, OT) Nursing student Undergraduate Graduate Student in Nursing, MSN Graduate Student in Nursing, PhD Nurse who became disabled before licensure Nurse who became disabled after licensure Person with disability Nurse Educator for LPN Education Nurse Educator for ADN Education Nurse Educator for BSN Education Nurse Administrator for ADN Education Nurse Administrator for BSN Education Nurse Administrator for LPN Education Nurse Administrator for Graduate Nursing Education Registered Nurse Licensed Practical Nurse Member of state board of nursing Disability Service Professional Nurse Employer/Recruiter Other Other Professional If Other, please describe...
9) Which of the following categories best describes your age?
18-29 years of age 30-39 years of age 40-49 years of age 50-59 years of age 60-69 years of age
10) If you are a nursing student, nurse, nurse educator, or a member who has a disability, please indicate your disability if you choose.
11) If applicable, was the application process for admission into a nursing school accessible (e.g., alternate formats available, wheelchair access, chemical free environment) to you?
Yes No If no, please describe...
12) If applicable, were you able to obtain accommodations for your disability in a nursing school?
Yes No Not Applicable If no, please describe...
13) If applicable, were you denied accommodations while enrolled in nursing school?
Yes No Not Applicable If yes, please describe...
14) If applicable, were you able to obtain accommodations for your disability at your place of employment?
15) If applicable, were you denied accommodations at your place of employment?
Thank you for taking the time to complete this evaluation and share your feedback and comments to us. Please visit our website at NOND to see available resources for nursing students with disabilities. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Do you have any additional questions or comments? If so, please feel free to email us at NOND Info.