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Excellence in Nursing: 2018 Nominations

Deadline for nominations is Friday, Aug. 10, 2018. Winners will be notified in October, 2018.
 

Nomination Categories (Check all that apply)

Advanced Practitioner

Leadership / Executive

Academic

Researcher

Community

 Clinician

 Other 
 

Education (Check all that Apply)

Registered Nurse
Where did this nominee obtain his/her certification?* 

Bachelor's Degree
Where did this nominee obtain his/her certification?* 

Masters Degree
Where did this nominee obtain his/her certification?*  

Doctoral Degree
Where did this nominee obtain his/her certification?* 

 

Nominee Information

Nominee First Name*

Nominee Last Name*

Nominee Age*:   

Nominee Gender:   Male      Female       Other  

Nominee Work Address: 

City:      

State:       Zip:  

Nominee Home Address: 

City:      

State:       Zip:  

Does the nominee currently live in Western Pennsylvania?*: Yes   No  

Nominee Phone Number*:     

Nominee E-Mail*:  

Nominee Place of employment*:  

Nominee Current title*

Nominator Information  

This is a self-nomination: 
 

Nominator First Name      

Nominator Last Name      

Nominator E-mail      

Describe the nominee's impact on his/her work environment.

Describe the nominee's greatest professional accomplishment.

Provide an example showing how the nominee demonstrates excellence through the effective management of patient care:

Provide an example showing how the nominee demonstrates nursing skill and knowledge through creativity, problem-solving and on-going educational activities:

Additional comments/notes:

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