NICHE Coordinator Boot Camp Application
The NICHE Coordinator Boot Camp is offered to existing NICHE member sites that have newly appointed coordinators.  This application will assist the NICHE faculty to determine if this educational activity is a good fit for the applicant. Please complete each section of the application. Once your application is reviewed and approved we will send you the registration/payment link by email.   
Information  shared in this application will NOT impact your organization's current NICHE recognition level. 
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Email *

Full Name

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Credentials (degrees, licenses, certifications, honors)
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Organization Name
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Mailing Address (This should be the address where you want your textbook mailed to)
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Phone Number   suggested format (xxx-xxx-xxxx)
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Current Role/Position 
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To which NICHE Coordinator Boot Camp Session are you applying?  *

Tell Us About Your Organization’s NICHE Program 

The next set of questions focus on the NICHE program implementation in your organization.  

On average, how much time are you currently devoting to leading and managing NICHE program activities on a weekly basis? 
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How long have you served as the NICHE Coordinator?  (years and months)

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How many nursing units are designated NICHE units?
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Approximately how many of your NICHE units have nurses who are Geriatric Resource Nurses (GRNs)?

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To what extent do you feel prepared to assume the NICHE Coordinator role to lead the implementation of the NICHE practice model to advance clinical excellence in geriatric nursing? 

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Please list three goals that you would like to achieve by attending the NICHE Coordinator Boot Camp.   

Goal 1:

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Goal 2:
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Goal 3: 
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Describe the current state of your organization’s NICHE Program. 

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NICHE Member Services  

In order for the national program office team to facilitate your onboarding into the NICHE Coordinator role, please reflect on your personal use of the following NICHE member benefits and services. If you are unfamiliar with the resources listed below please mark “Do Not Know.”    

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Using
Not Using
Did Not Know About this Resource
NICHE Protocol Book 6th Edition
NICHE Program and Implementation Textbook
Knowledge Center (Learning Management System) Account
Access to the Coordinator Corner Section in the Knowledge Center
Geriatric Nursing Subscription (Elsevier)
Quarterly NICHE News member newsletter
NICHE Pocket Cards
Email notices marketing the NICHE Webinars, Events, Meetings
Annual Membership Renewal Invoice
Member Recognition Certificate and Digital Badge
NICHE Marketing Kit

Do you have any questions about the NICHE Program or the Coordinator role? 

If no please type N/A as your answer 

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End of Application
A copy of your responses will be emailed to the address you provided.
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