Sample Completed Fellow Application

Fellow Application -...

Questions

Introduction

Thank you for your interest in applying for the Fellowship of the Association of Pediatric Hematology/Oncology Nurses (FAPHON) designation. Although applications may be submitted year-round, they must be submitted by the last day of February to be considered for inclusion that year at Conference (e.g., submit your application by February 28, 2023, for it to be considered for induction in 2023; if you submit your application on March 1, 2023, it will be considered for induction in 2024). Demonstrated accrual of a minimum of 100 points, including a minimum of 40 points in Section 1 of the application, is necessary for consideration as defined on the APHON Fellow application. Applicants are encouraged to include ALL professional activities that highlight their contributions and impact on the field (i.e., provide a complete presentation of activities, not just those that add up to 100 points). Professional activities can only be submitted for one category. Duplication of activities in different sections of the application will not be considered. Completed applications will be reviewed for contributions and impact on the field; a quantitative score of 100 or greater does not guarantee the Fellow designation. If at any point you do not have any information to enter into a question field, please write "N/A" in the relevant field(s). This will ensure to us that you have reviewed the question.

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Contact Information

Contact Information First Name*: (Max. Characters: 20) Last Name*: (Max. Characters: 30) E-mail*: (Max. Characters: 300)

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Section 1: Activities in Support of or Service to APHON

List your service as a member of the National Board of Directors*:

4 points per term, if within 5 years; 3 points per term, if between 5-10 years ago; 2 points per term, if more than 10 years prior; maximum 16 points. If you served as President as APHON, you may indicate 4 points for your presidency regardless of when your term began/ended. Because members of the Board of Directors are ineligible for consideration while serving, you may claim the maximum points within 12 years of your term ending. Position Years of Term

List any service as a Local Chapter President*:

4 points per term, if within 5 years; 3 points per term, if between 5-10 years ago; 2 points per term, if more than 10 years prior; maximum 16 points Chapter Position Years of Term

List service as a member*:

List service as a member of an ONCC ® , CPON ® , CPHON ® , or BMTCN ® Exam Development Committee 4 points per term, if within 5 years; 3 points per term, if between 5-10 years ago; 2 points per term, if more than 10 years prior; maximum 16 points ONCC Specific Exam Development Committee Years of Term

List service as APHON Committee Chair or task force chair for

(See a list of committees/task forces.) 4 points per term, if within 5 years; 3 points per term, if between 5-10 years ago;

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APHON National*:

2 points per term, if more than 10 years prior; maximum 16 points Because members of the Professional Development Committee are ineligible for consideration while serving, you may claim the maximum points within 12 years of your term ending. APHON Position Years of Term

List any service as a member of an APHON committee or task force*:

(See a list of committees/task forces). Not eligible to earn points as a chair/co- chair and member of a committee or task force in the same year. (Note: For APHON chapter membership, only service as an executive board member is eligible for this category. Executive board members include president, VP, Secretary, and Treasurer.) 4 points per term, if within 5 years; 3 points per term, if between 5-10 years ago; 2 points per term, if more than 10 years prior; maximum 16 points

APHON National Committee Position*:

APHON National Committee Position

Years of Term

APHON Local Chapter Committee Position*:

APHON Local Chapter Committee Position

Years of Term

ONCC Committee Position*:

ONCC Committee Position

Years of Term

List participation as an invited faculty/presenter at an APHON educational offering*:

(e.g., Annual Conference, APHON-sponsored Spring Conference, APHON sponsored webinars/e-Learning, APHON Certification Review Course for CPON ® or CPHON ® exams.) (Presentation of concurrent sessions is not eligible for points for this entry.) 4 points per year, if within 5 years; 3 points per year, if between 5-10 years ago; 2

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points per year, if more than 10 years prior; maximum 16 points

Title

Meeting

Month/Year

List any service as an author of a book chapter or nursing education curriculum produced by APHON*:

Please see the list of eligible resources provided. 5 points per publication, points if within 5 years; 4 points per publication, if between 5-10 years ago; 3 points per publication, if more than 10 years prior; maximum 15 points

Publication

Specific Chapter

Service as an editor*:

List any service as an editor or section editor of a book or nursing education curriculum produced by APHON. Please see the list of eligible resources provided. 5 points per publication, if within 5 years; 4 points per publication, if between 5-10 years ago; 3 points per publication, if more than 10 years prior; maximum 15 points

Publication

Year Published

List any service as a reviewer for APHON for any of the following*:

• Manuscript review for the Journal of Pediatric Hematology/Oncology Nursing ( JOPHON ) • Content review for any publication or presentation produced by APHON, including electronic media review. Note: If the review of content, abstracts, or manuscripts is your responsibility as a member of an APHON committee, you are not eligible to earn points for such committee work in this category as it is captured in your committee work. 2 points per article, if within the past 5 years; 1 point per article, if within the past 5-10 years; maximum 8 points Type of Review Start/End Date

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Additional Materials: (Max. Characters: 5000)

If there are any remaining items that you believe should be considered in this section but you weren't sure where to put them, please describe those items here. List if you have served as an editor or on an editorial board for the Journal of Pediatric Hematology/Oncology Nursing ( JOPHON ) or APHON Counts . 4 points per term, if within 5 years; 3 points per term, if between 5-10 years ago; 2 points per term, if more than 10 years prior; maximum 16 points for JOPHON 3 points per term, if within 5 years; 2 points per term, if between 5-10 years ago; 1 point per term, if more than 10 years prior; maximum 12 points for APHON Counts

Editor or on an editorial board*:

Publication and Role

Start/End Date

Service to APHON in non-Board role*:

List any service to APHON in a non-Board role that furthered the mission of APHON (e.g., writing/reviewing position statements or educational products, including electronic products, [for example, disease booklets]). Please see eligible activities from the list provided. 3 points per activity, if within 5 years; 2 points per activity, if between 5-10 years ago; 1 point per activity, if more than 10 years prior; maximum 12 points

Activity

Start/End Date

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List if you were a recipient of an award given by APHON or ONCC*:

Please see the list of eligible awards from the list provided. (4 points per award, maximum 12 points)

Award

Year

List if you were a recipient of a scholarship given by APHON or ONCC*:

Please see the list of eligible awards from the list provided. (2 points per scholarship, maximum 12 points)

Award

Year

List research or clinical grants received given by APHON*:

(3 points per grant, maximum 9 points)

Project Title

Period of Grant Award

Section 1 Points*:

Enter the points you have for each category in this section. The total field will automatically total after you save the page. List your service as a member of the

National Board of Directors (4 points per term, if within 5 years; 3 points per term, if between 5-10 years ago; 2 points per term, if more than 10 years prior; maximum 16 points): List any service as a Local Chapter President (4 points per term, if within 5 years; 3 points per term, if between 5-10 years ago; 2 points per term, if more than 10 years prior; maximum 16 points): List service as a member (4 points per term, if within 5 years; 3 points per term, if between 5-10 years ago; 2 points per term, if more than 10 years prior; maximum 16 points): List service as APHON Committee Chair or task force chair for APHON National (4 points per term, if within 5 years; 3 points per term, if between 5-10 years ago; 2 points per term, if more than 10 years prior; maximum 16

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points): List any service as a member of an APHON committee or task force (4 points per term, if within 5 years; 3 points per term, if between 5-10 years ago; 2 points per term, if more than 10 years prior; maximum 16 points): List participation as an invited faculty/presenter at an APHON educational offering (4 points per year, if within 5 years; 3 points per year, if between 5-10 years ago; 2 points per year, if more than 10 years prior; maximum 16 points): List any service as an author of a book chapter or nursing education curriculum produced by APHO (5 points per publication, points if within 5 years; 4 points per publication, if between 5-10 years ago; 3 points per publication, if more than 10 years prior; maximum 15 points): Service as an editor (5 points per publication, if within 5 years; 4 points per publication, if between 5-10 years ago; 3 points per publication, if more than 10 years prior; maximum 15 points): List any service as a reviewer for APHON (2 points per article, if within the past 5 years; 1 point per article, if within the past 5-10 years; maximum 10 points): Editor or on an editorial board (4 points per term, if within 5 years; 3 points per term, if between 5-10 years ago; 2 points per term, if more than 10 years prior; maximum 16 points for JOPHON) (3 points per term, if within 5 years; 2 points per term, if between 5-10 years ago; 1 point per term, if more than 10 years prior; maximum 12 points for APHON Counts): Service to APHON in non-Board role (3 points per activity, if within 5 years; 2 points per activity, if between 5-10 years ago; 1 point per activity, if more than 10 years prior; maximum 12 points): List if you were a recipient of an award given by APHON or ONCC (4 points per award, maximum 12 points): List if you were a recipient of a scholarship given by APHON or ONCC (2 points per scholarship, maximum 12 points) : List research or clinical grants received given by APHON (3 points per grant, maximum 9 points) : Total (click Save to update):

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Section 2: Certification, Presentations, Publications, and Research

If at any point you do not have any information to enter into a question field, please write "N/A" in the relevant field(s). This will ensure to us that you have reviewed the question. Please see the bottom of this section to compile your points per question. You may use this feature to double check that you are meeting the minimum points requirements in order to be eligible for consideration (minimum of 40 points in Section 1 and minimum of 100 points total). Certifications*: List currently held ONCC Certification(s), including CPON ® , CPHON ® , or BMTCN ® . (3 points per certification, maximum 6 points)

Credential

Year Earned

List abstracts presented as posters/papers at an APHON Annual Conference*:

(1 point per presentation, maximum 6 points)

Title

Meeting

Month/Year

Preconference*:

List preconference and concurrent sessions given at an APHON Annual Conference or other peer-reviewed forums. (1 point per presentation, maximum 6 points)

Presentation Title

Meeting

Month/Year

Presentations*:

List presentations at an APHON Local Chapter Education Meeting or other local or regional peer-reviewed forums. Industry-sponsored presentations are excluded. (1 point per presentation, maximum of 8 points)

Presentation Title

Meeting

Month/Year

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Invited Faculty*:

List participation as invited faculty or presenter at educational forums relevant to the specialty of pediatric hematology/oncology nursing other than APHON Annual Conference or APHON Local Chapter Education Meeting (e.g., HPNA, ONS, NAPNAP, ANCC, COG, etc.). 3 points, if within 5 years; 2 points, if between 5-10 years ago; 1 point, if more than 10 years prior; maximum 12 points

Presentation Title

Meeting

Month/Year

Research and Clinical Reviews*:

List research and clinical review articles relevant to the specialty of pediatric hematology/oncology nursing published in the Journal of Pediatric Oncology Nursing (JPON) or other peer-reviewed journals. List Articles in APA 7th Edition Format 3 points, if within 5 years; 2 points, if between 5-10 years ago; 1 point, if more than 10 years prior; maximum 12 points

Article Title

Publication

Book Chapters*:

List any book chapters or nursing education curriculum that you authored that were not produced by APHON but are relevant to the specialty of pediatric hematology/oncology nursing. List Titles in APA 7th Edition Format 3 points, if within 5 years; 2 points, if between 5-10 years ago; 1 point, if more than 10 years prior; maximum 12 points

Title

Publication

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Editor or Author of a book*:

List any instance of being an editor or author of a book nursing education curriculum not produced by APHON but relevant to the specialty of pediatric hematology/oncology nursing. List Titles in APA 7th Edition Format 3 points, if within 5 years; 2 points, if between 5-10 years ago; 1 point, if more than 10 years prior; maximum 12 points

Book Title and Role

Content Reviewer*:

List any service as a content reviewer of publications not produced by APHON but related to the specialty of pediatric hematology/oncology nursing, including electronic media. List Titles in APA 7th Edition Format (1 point per instance, maximum 4 points)

Publication Title

Editor or on an editorial board*:

List if you have served as an editor or on an editorial board for peer-reviewed journals other than JOPHON , which are relevant to the specialty of pediatric hematology/oncology nursing. (2 points per publication, maximum 8 points)

Publication

Role

Start/End Date

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Research or clinical grants received *:

List research or clinical grants received relevant to the specialty of pediatric hematology/oncology nursing. (3 points per grant, maximum 9 points)

Project Title

Granting Agency

Project Dates

Additional Materials: (Max. Characters: 5000)

If there are any remaining items that you believe should be considered in this section but you weren't sure where to put them, please describe those items here. Enter the points you have for each category in this section. The total field will automatically total after you save the page. Certifications (3 points per certification, maximum 6 points): List abstracts presented as

Section 2 Points*:

posters/papers at an APHON Annual Conferenc (1 point per presentation, maximum 6 points): Preconference (1 point per presentation, maximum 6 points): Presentations (1 point per presentation, maximum of 8 points): Invited Facult (3 points, if within 5 years; 2 points, if between 5-10 years ago; 1 point, if more than 10 years prior; maximum 12 points): Research and Clinical Review (3 points, if within 5 years; 2 points, if between 5-10 years ago; 1 point, if more than 10 years prior; maximum 12 points): Book Chapters (3 points, if within 5 years; 2 points, if between 5-10 years ago; 1 point, if more than 10 years prior; maximum 12 points): Editor or Author of a book (3 points, if within 5 years; 2 points, if between 5-10 years ago; 1 point, if more than 10 years prior; maximum 12 points): Content Reviewer (1 point per instance, maximum 4 points): Editor or on an editorial board (2 points per publication, maximum 8 points): Research or clinical grants received (3 points per grant, maximum 9 points): Total (click Save to update):

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Section 3: Service Through Teaching/Mentoring

If at any point you do not have any information to enter into a question field, please write "N/A" in the relevant field(s). This will ensure to us that you have reviewed the question. Please see the bottom of this section to compile your points per question. You may use this feature to double check that you are meeting the minimum points requirements in order to be eligible for consideration (minimum of 40 points in Section 1 and minimum of 100 points total). Service precepting interdisciplinary learners*: List any service precepting interdisciplinary learners with direct supervision provided to a student enrolled in a formal accredited academic healthcare education program. The precepting should be in a one-on-one relationship with specific goals to learn information about the specialty of pediatric

hematology/oncology care and the role of the disciplines involved. One-day shadowing experiences will not be accepted. A minimum of 25 hours is required. (3 points per preceptorship, maximum 12 points)

Student Academic Level

School/Program

Dates

Formal structured educational presentation*:

List participation in a formal structured educational presentation made to laypersons (e.g., lectures to civic groups, public service announcements, radio or TV appearances). The content of the presentation must be related to the field of pediatric hematology/oncology care. (1 point per presentation, maximum 10 points)

Topic

Organization

Month/Year

Teaching award*:

List any teaching award or teaching honor for services relevant to the specialty of pediatric hematology/oncology nursing. 3 points, if within 5 years; 2 points, if between 5-10 years ago; 1 point, if more than 10 years prior; maximum 12 points

Award/Honor

Group

Location

Month/Year

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Section 3 Points*:

Enter the points you have for each category in this section. The total field will automatically total after you save the page.

Service precepting interdisciplinary learners (3 points per preceptorship, maximum 12 points) : Formal structured educational presentation (1 point per presentation, maximum 10 points): Teaching award (3 points, if within 5 years; 2 points, if between 5-10 years ago; 1 point, if more than 10 years

prior; maximum 12 points): Total (click Save to update):

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Section 4: Public Service

List any non-APHON state or national committee or task force relevant to the specialty of pediatric hematology/oncology nursing of which you are a member. (Examples: Legislative committee or task force for state/national membership organizations, e.g., COG, ANA, NAPNAP, AAHPM, CAPC, NHPCO, PQLC, SWPN, ION, NQF, NCP, etc.) (2 points per year of service, 10 maximum points)

Organization

City/State

Term of Service

Professional honors or awards*:

List any professional honors or awards you have received relevant to the specialty of pediatric hematology/oncology nursing from sources other than APHON. (2 points per activity, maximum 6 points)

Honors or Award

Organization

Section 4 Points*:

Enter the points you have for each category in this section. The total field will automatically total after you save the page.

Non-APHON state or national committee (2 points per year of service, 10 maximum points): Professional honors or awards (2 points per activity, maximum 6 points): Total (click Save to update):

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Section 5: Statement of Contributions and Impact

Leadership and unique contributions*: (Max. Characters: 4500)

This section provides you an opportunity to succinctly describe how your leadership and unique contributions have impacted the field of pediatric hematology/oncology nursing. Please be as specific as possible when providing data to support the impact of your work; remember that the events described in this section must align with your CV.

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Section 6: Statement of Future Engagement

Mission of APHON*: (Max. Characters: 4500)

Please describe how your significant contribution(s) supports the mission of APHON and how you will continue to uphold advancing pediatric hematology/oncology care if named an APHON Fellow.

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Additional Requirements

Upload Documents Below Please upload the required following documents as part of your application to the APHON Fellow program. • LETTERS OF RECOMMENDATION (2) ☐ Two written letters of recommendation (LOR) are required and must be received by the application deadline. ☐ At least one of the two required recommendation letters must be authored by an APHON member. Those writing letters of recommendation should state how long they have known the applicant and what capacity. (No one person may write more than two letters a year for applicants. Members of the Professional Development Committee or the Board of Directors are not eligible to serve as a reference.) ☐ Professional peers should be chosen who know the applicant’s work well enough to verify and provide exemplars about the applicant’s strengths, contributions, and impact on the field of hematology/oncology nursing. Please share the following links for your peers to submit their LORs: LOR from a member LOR from a professional colleague • CURRICULUM VITAE (CV) ☐ CV content should match and/or substantiate the information contained in the application. Relevant activities from the CV should be documented in the application.

Type

Name

Size

Updated

Curriculum Vitae (CV) *

Notes

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Application Attestation

I certify that the information provided in this application accurately represents my professional status and experience. Furthermore, I recognize that any falsified information may lead to the revocation of my Fellow status. I also understand that the application fee is non-refundable, regardless of the outcome of the application process. I acknowledge that Fellow status is granted at the sole discretion of the Association of Pediatric Hematology/Oncology Nurses Board of Directors and includes many variables, including but not limited to the contents of this application. By typing my name below, I am electronically signing my application, and this will be considered the same as a written signature.

Name*: (Max. Characters: 300) Date (MM/DD/YYYY)*: (Max. Characters: 10)

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