WSNA Recognition Awards Nomination Form

Nomination deadline: January 31, 2019

Nominee

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* 1. Nominee contact information:

First Name *

Last Name

Nominee's Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Nominee's Email Address *

Nominee's Phone Number *

Award

Please select the award category/categories for which you are nominating this person.
Read full details on each award, including criteria.

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* 2. WSNA Awards

Honorary Recognition Award

Marguerite Cobb
Public Health/Community Health
Nurse Award

Joanna Boatman
Staff Nurse Leadership Award

ANA Honorary Membership Pin

Community Partner Award

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* 3. Professional Nursing and Health Care Council Awards:

Excellence in Practice Award

Leadership and Management Award

Nurse Educator Award

Ethics and Human Rights Award

Nurse Researcher Award

Why this person should win

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* 4. Please describe how the nominee meets the award criteria in 300 words or less, listing the nominee's credentials and achievements.

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* 5. Provide a copy of the nominee's curriculum vitae/resume

PDF, DOCX, DOC file types only.

Choose File

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* 6. Nominated by:

Name *

Organization

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

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* 1. Nominee contact information:

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* 2. WSNA Awards

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* 3. Professional Nursing and Health Care Council Awards:

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* 4. Please describe how the nominee meets the award criteria in 300 words or less, listing the nominee's credentials and achievements.

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* 5. Provide a copy of the nominee's curriculum vitae/resume

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* 6. Nominated by:

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* 7. Relationship to nominee: