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					  SELF-REFLECTIVE ASSESSMENT FOR AHNCC
     CERTIFICATION IN HOLISTIC NURSING:
 INTERACTIVE FORM AND GUIDELINES FOR THE
             HN-BC CANDIDATE




  Applicant Code Number (Last four SSN digits)


American Holistic Nurses’ Credentialing Corporation
                 811 Linden Loop
              Cedar Park, TX 78613
                        The American Holistic Nurses’ Credentialing Corporation
                    Self-Reflective Statements and Guidelines for HN-BC Candidates

           AHNCC Certification Process Self-Reflective Assessment Application Form
                                      HN-BC Candidates.

Please complete this interactive form and the three (3) self-reflection situations listed on the
following pages. To type directly on this form, click on the line and type.

Name (Last)                                     (First)                        (Middle)
                           (Maiden)

Address:




City:                                 State:                                Zip
code:                                  Telephone:

(Home)                             (Work)
                                               (Cell)



Email Address:                                                                        Secondary
email


Last four digits of SSN

Please read and sign the following statement:

Honor Code: I understand and agree that all the documents submitted by me for the Self-Reflective
Assessment are based on my self-reflection and self-assessment. I also understand and agree that
all statements in my self-assessment refer to my personal life situation and experiences.

Printed signature



Personal signature




For office use only:


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                  The American Holistic Nurses’ Credentialing Corporation
              Self-Reflective Statements and Guidelines for HN-BC Candidates



AHNCC decision:_________________________________________________________________
Notes:




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                      The American Holistic Nurses’ Credentialing Corporation
                  Self-Reflective Statements and Guidelines for HN-BC Candidates

 All materials submitted are based on your honor system as described in the Self-Reflective
                               Assessment application form.

1. Develop statements regarding each of the situations listed below. Use your own words and
   experiences to fully discuss/describe your life and experiences. Use self-reflection as a method
   to describe how you have integrated Holistic Nursing Principles into your personal and
   professional lives. For assistance see AHNA‘s Scope and Standards for Holistic Nursing
   Practice (2007, pp. 6-8) or click here.
Adhere to the following guidelines:

         Titles and subject headings are required for each section. Create your title from words
       used in the discussion. For example: the title might be: The Conceptual Foundations of my
       Holistic Nursing Practice. The subject head might be Conceptual Foundations.

         Start each question on a new page. Responses to each question are limited to (3)
       pages.

         Paper size: 81/2 x11”; Margin size: 1ʼ left and right and 1” top and bottom.

         Font size: Times or Times New Roman, 12 font.

         Spacing: responses must be double spaced.

         Type or word-process all statements.

         Mail your SRA with your application packet to:




                  AHNCC Certification Application
    Professional Testing Corporation, 1350 Broadway, 17th Floor
                    New York, New York 10018
              Phone: 212-356-0660, Fax: 212-356-0678
                            ahncc@ptcny.com.




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                     The American Holistic Nurses’ Credentialing Corporation
                 Self-Reflective Statements and Guidelines for HN-BC Candidates

Last four digits of your SSN

Title:


1      Think about an extant holistic nursing theory or theories and related concepts and assess
how they guide your life and practice (e.g. Watson, Newman, Erickson, Parse, Rogers, and
Nightingale).




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                      The American Holistic Nurses’ Credentialing Corporation
                  Self-Reflective Statements and Guidelines for HN-BC Candidates

Last four digits of your SSN

Title:


2.     Reflect on your personal and professional holistic nursing journey and discuss how it
affects who you are today.




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                  Self-Reflective Statements and Guidelines for HN-BC Candidates

Last four digits of your SSN

Title:


3. Reflect on a situation that occurred in your professional practice within the last year in which you
applied concepts of holistic nursing and assess the impact it had on you as a professional.




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