Professional Nursing Awards
Nomination Form - Fall 2020

Nominees and nominators must:

Be a member of the Association
Not be a current member of the Association's board of directors, staff or awards committee

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* 1. Which award are you submitting a nomination for?

Nominee Information

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* 2. Name of nominee

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* 3. Registration/ID number

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* 4. Contact information

Phone Number

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* 5. Current position title

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* 6. Employer

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* 7. Years of nursing practice

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* 8. By checking this box, I confirm that I have contacted the nominee and they have provided their consent to be nominated.

Yes

Lead Nominator Information

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* 9. Name of nominator

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* 10. Registration/ID number

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* 11. Contact information

Phone Number

Supporting Nominator Information

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* 12. Name of nominator

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* 13. Registration/ID number

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* 14. Contact information

Phone Number

Supporting Documents

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* 15. How does the nominee meet the award criteria?

Please upload a document that provides 5-10 examples that demonstrate how the nominee meets the award criteria. Examples can be in paragraph or bullet form with a maximum of 500 words.

PDF, DOC, DOCX file types only.

Choose File

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* 16. Nominee resume

For those submitting nominations for the team award, please upload a list of team members and their registration numbers.

PDF, DOC, DOCX file types only.

Choose File

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* 17. Optional: Supporting links (such as professional online/social media sites, news articles, research studies)

Link One

Link Two

Link Three