Sample Completed Fellow Application

27. 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



Supporting siblings of kids with cancer Community support for kids with cancer and their families

Illinois School District September 2018, 2019 and 2020 Kiwanis Club of Illinois March 2018

Self-care matters

Ronald McDonald House staff Candlelighters

June 2019, 2020

Parent support group February 2018 to present 28. 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 Pediatric educator of the year Chicago IL January 2018

Children’s Hospital of Illinois U of Illinois School of Nursing

Outstanding pediatric clinical preceptor

Chicago, IL

March 2020

Section IV Public Service

29. 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

COG BMT Committee


September 2018- present

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