Policy Verification Form

Role You Are Applying For *

Enter required value Board of Directors Development Committee Education Committee Nominations Committee Program Committee Strategic Plan Theme 1 Strategic Plan Theme 2 Strategic Plan Theme 3 Strategic Plan Theme 4

First Name *

Last Name *

Conflict of Interest Policy *

View Policy →

The APSNA mission is that APSNA will be the voice that shapes pediatric surgical nursing through advocacy, collaboration, mentorship and leadership. Based on a foundation of research, education and innovation, APSNA will transform care delivery for pediatric surgical patients. This mission is the primary interest that will be prioritized in all APSNA activities. A conflict of interest thus compromises an individual’s accountability to APSNAs Mission and to those that APSNA aims to serve and risks erosion of the trust placed in APSNA to fulfill this mission.

APSNA requires individuals subject to the Conflict of Interest Policy to read this policy, confirm receipt and agree to compliance, and to disclose all relevant interests, including, but not limited to financial relationships with entities that could be affected financially by the activities of APSNA, such as Pharmaceutical, Biotech, Food & Nutrition, and Medical Devices and Equipment companies, or foundations, advocacy groups, or other organizations supported by entities that may have a financial stake in the outcome. Public funding sources, such as government agencies or academic institutions need not be disclosed. Time period for disclosure is within 5 years from when this form is completed.

I have read the Conflict of Interest Policy and I agree to comply in all respects with this policy.

Yes, I agree.

Information Technology (IT) Resources and Communication Systems Policy *

View Policy →

Please indicate below that you received a copy of APSNA’s IT RESOURCES AND COMMUNICATION SYSTEMS POLICY and that you read it, understood it and agree to comply with it. You understand that APSNA has the maximum discretion permitted by law to interpret, administer, change, modify or delete this policy at any time with or without notice. No statement or representation by an officer or director of, whether oral or written, can supplement or modify this policy. Changes can only be made if approved in writing by the board of directors of APSNA. You also understand that any delay or failure by APSNA to enforce any policy or rule will not constitute a waiver of APSNA’s right to do so in the future.

Acknowlegement of Receipt and Review - IT Policy

I received, read, understand and agree to comply.

Nondiscrimination / Anti-Harassment Policy *

View Policy →

Please indicate below that you acknowledge that, you received and read a copy of the Nondiscrimination / Anti-Harassment Policy of the American Pediatric Surgical Nurses Association, Inc. and understand that it is your responsibility to be familiar with and abide by its terms. You understand that the information in this Policy is intended to help APSNA’s employees, directors, officers, members and volunteers to work together effectively on assigned responsibilities.

Acknowledgement of Recepit and Review - Nondiscrimination / Anti-Harassment Policy

I received, read, understand and agree to comply.

Statement of Values and Ethical Standards Policy *

View Policy →

Please indicate below that you have read the Statement of Values and Ethical Standards Policy.

Acknowledgement of Receipt and Review - Values and Ethical Standards Policy

I received, read, understand and agree to comply.

Diversity and Inclusion Policy *

View Policy →

Please indicate below that you have received a copy of the APSNA Diversity and Inclusion Policy. You have read and understand the policy and agree to comply with it.

Acknowledgement of Recepit and Review - Diversity and Inclusion Policy

I received, read, understand and agree to comply.

Bullying and Incivility Policy *

View Policy →

Please indicate below that you have received a copy of the APSNA Bullying and Incivility Policy. You have read and understand the policy and agree to comply with it.

Acknowledgement of Recepit and Review - Bullying and Incivility Policy

I received, read, understand and agree to comply.

Social Media Policy *

View Policy →

Please indicate below that you have received a copy of the APSNA Social Media Policy. You have read and understand the policy and agree to comply with it.

Acknowledgement of Receipt and Review - Social Media Policy

I received, read, understand and agree to comply.

Interactions with Industry Policy *

View Policy →

Please indicate below that you have received a copy of the APSNA Interactions with Industry Policy. You have read and understand the policy and agree to comply with it.

Acknowledgement of Receipt and Review - Interactions with Industry Policy

I received, read, understand and agree to comply.