Exit this survey

2019 NSRC Regional Respiratory Therapist of the Year Nominations

2019 NSRC Regional Therapist of the Year

Please fill out the information as completely as possible.

1.Your nominee for Regional RespiratoryTherapist of the Year, MUST be an AARC member and practice in the state of Nebraska. Select the appropriate region for your candidate: Omaha, Lincoln, or Out State Nebraska.

2. The essay about your nominee must consist of a minimum of 2 or more of the requested character attributes: Patient/Customer Focus, Professionalism, Teamwork, Quality and Innovation, and or Other Characteristics.

3. Fill out the contact information completely for you and your nominee.

Questions and suggestions regarding this survey can be sent to Christine Villegas, NSRC Publications and Web chairman or Travis Kirchner, NSRC President. Contact information can be found on the NSRC website. at www.NSRC-online.org
Thank you for your nomination.

Question Title

* 1. Select the region in Nebraska where the candidate works?

Region Omaha

Region Lincoln

Region Out State Nebraska

Question Title

* 2. Person submitting the nomination. We may need to contact you regarding your nomination.

Name:

AARC Number

Address:

City/Town:

State:

Zip:

E-mail Address:

Phone number:

Question Title

* 3. Nominee Name and Respiratory Credentials

Name & Credentials

Nominee's AARC Number

Question Title

* 4. Nominee Contact Information

Company Nominee works for:

Address:

City/Town:

State:

Zip:

Nominee's E-mail Address:

Nominee's Phone Number:

Question Title

* 5. Your candidate works in the following respiratory care environment.

Hospital

Home Care

Rehabilitation

Sleep

Diagnostics and PFTs

Respiratory therapy education

Other (please specify)

Question Title

* 6. Patient/Customer Focus: Explain how the nominee has performed "beyond the call of duty" to provide safe and compassionate patient care?

Question Title

* 7. Professionalism: Describe the nominee's professionalism and dedication to their patients, colleagues, organization, community, state, and/or national professional organization.

Question Title

* 8. Teamwork: Give a narrative that demonstrates the nominee's "spirit of team work."

Question Title

* 9. Quality and Innovation: Tell the nominee's story on developing ideas, projects, initiatives, that resulted in benefits for their patients, organization, community, or state.