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Child Neurology Foundation Excellence in Transition of Care Award 2021: Nomination Form

Please fill out the below sections with information about how and why the person or institution exemplifies best practices and excellence in transition to adult neurology care. 

Applications are due September 30, and winners will be notified on or before October 29.

Selected people or institutions will receive a digital badge to put on their website identifying them as recipients of the CNF 2021 Excellence in Transition of Care Award. Individuals will also have the opportunity to share best practices in an interview that highlights their practice.

Please direct questions to jnickrand@childneurologyfoundation.org.
1.What is your contact information?(Required.)
2.What is the contact information of the institution and/or clinician(s) you are nominating? Self-nominations are encouraged.(Required.)
3.If you are not nominating yourself, how do you know the nominee?
4.What kind of patients does the nominee serve? Check all that apply.(Required.)
5.How does the institution/clinician(s) exemplify best practices in transition of care? (Please no more than 500 words).(Required.)
6.What resources for patients does the institution/clinician(s) provide for transitioning patients and their families? Please check all that apply.(Required.)
7.What resources for clinician education and support does the nominee provide for continuing education and sharing and implementing best practices? Please check all that apply.(Required.)
8.Please share positive feedback about the nominee's success in transition of care. This can include patient testimonials, personal stories, quality metrics and data, or any other information that helps you tell this story. (Please no more than 250 words)(Required.)
9.What has the nominee done to change practices of the institution or colleagues to promote patient centered transition of care? (Please no more than 250 words)(Required.)
10.Is there anything else you want CNF to know about the institution/clinician(s) you're nominating?
11.By signing my name below, I verify that everything that I have included is correct and truthful to the best of my knowledge and ability. I am aware that by submitting this to CNF, CNF may reach out to the nominee directly.(Required.)
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