Complete number 1,4,5,6 and 7 of the form don’t fill out number 2 and 3 of the form. 1. Introduction that includes a professional goal(s) statement. 2. Current license and credentials. 3. Reference list comprising of at least three references (one professional from work setting, one professional from school setting, and one personal reference) with two letters of reference. 4. Integration of the Boyer’s model for scholarship and the National League for Nursing (NLN) eight competencies for nurse educators, outlining your accomplishments in each of the eight areas. 5. Fully developed lesson plan from practicum experience. 6. Student learning assessment utilized in the practicum setting. 7. Reflective analysis assignment. Attached is the form.



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