2018 Excellence in Leadership Award

Share |

Leadership graphic

Thank you for nominating!

Please complete and submit by 5:00 PM Wednesday, October 24, 2018.

Please provide your information as the submitter of this nomination:
Nominee Name *		Nominee Title *
Address of Nominee *Address of Nominee
Hospital or Facility Where Nominee Works: *Please tell us the hospital/facility where the nominee works.
Address of Employer if applicable
Work PhoneTelephone of Nominee's work
Home or Cell PhonePlease provide either a home or a cell phone number.
Email Address of Nominee *
SUBMITTER INFORMATION:
First Name *		Last Name *
Professional Title		Organization *
Area Code *		Phone *
Email Address *
Question #1:
The nominee provides a mechanism for the interchange of ideas and dissemination of information relative to nursing administration / management:
a) Regarding nursing practice and/or legislative issues: *
b) Collaboration w/ other nursing groups and/or community entities such as schools, civic orgs, etc *
Question #2:
The nominee promotes education and other professional activities dealing with nursing administration and current health care issues:
a) Serves as a role model and mentor: *
b) Shares knowledge and expertise through presentations, seminars, publications, etc... *
Question #3:
Please include contact information for the nominees' CEO, supervisor or anyone that should be notified of the nomination:
CEO, Supervisor, Other Contacts to Notify: *

Edit This Favorite