Name of the person you are nominating:
Nominee's academic degree / certification (if known):
Nominee's Field/ Specialty:
Adult Intensive Care
Burn Care Nurse
Certified Nurse Midwife
Home Health Care
Labor and Delivery
Neonatal Intensive Care
Nurse Practitioner-Acute Care
Nurse Practitioner-Primary Care
Obstetrics Nurse, Gynecology
Wound, Ostomy, and Continence
Please select to the best of your ability. Winners will be contacted to confirm their field/specialty.
Please give us specific examples of how the nominee impacts the organization's standards or policies and/or impacts the nursing profession and community. (approx. 250 words)
Tell us about a specific time when the nominee went above and beyond while caring for a patient and/or the basic requirements of the role. (approx. 250 words)
Share any other examples that demonstrate why this nominee should be honored with this award. (approx. 250 words)
Upload nominee's CV or résumé here. It is not required, but suggested.
Your Phone Number:
Your relationship to the nominee:
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