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The nomination deadline is extended to March 15, 2024


IMPORTANT: This Nomination Form must be completed in a single session. You will not be able to partially fill it out and return at a later time.

Therefore, please complete the following before you begin this Nomination Form:

1) Read the Award’s Eligibility Criteria.

2) Decide which one of the four Awards best describes the person you want to nominate.

3) Ask two additional people to be Sponsors for this nomination and get their contact information to complete this Nomination Form.

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* 1. Nominator Information (This is YOU. The Nominator is the primary sponsor and contact person.)

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* 2. Nominee Information (This is the person you are nominating for an Award.)

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* 3. FOR LPN NOMINEES ONLY: I can confirm the LPN I'm nominating: 

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* 4. Sponsor 1  (For the Interprofessional Award, this should be another health discipline in the nominee’s work environment.)

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* 5. Sponsor 2

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* 6. Please choose the award category

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