Award Nomination Form

Nominated Nurse Information

Nominated Nurse Name (required)

Nominated Nurse Email (required)

Nominated Nurse Place of Employment

Nominator Information

Nominator Name (required)

Nominator Email (required)

Please indicate the category of nomination:
 Student Nurse Military Nurse Community Nurse Celebrity Nurse Retired Nurse Educator Nurse Entrepreneur Nurse Professional Nurse

Professional Nurse – LPN/RN exhibits excellent clinical skills, mentors students/staff, serves on work-related professional activities, problem-solves, innovates patient care and promotes interdisciplinary collaboration.

Celebrity Nurse – Speaks at 10 or more events yearly promoting health in community, local or nationally. Community engaging, dynamic speaker and presenter.

Community Nurse - Nurse is recognized as a community leader in health-related activities, leads health-related community projects, problem solves/innovates community based care, provides care over life continuum.

Retired Nurse - Nurse has successful completed over 20 years or more of services and is still inspired to give back, promote healthy living, mentoring younger nurses, and/or making a difference in her community.

Military Nurse – Active Duty/Reserve Military Nurse who performs above peers, excels in community service, and is a leader in their community.

Education Nurse - Nurse is employed as an experienced faculty in a nursing program or as an experience nurse educator/clinical nurse specialist in a clinical setting, is recognized as an excellent teacher motivating students to become better nurses, leaders, and future educators.

Student Nurse – Non licensed student nurse, excels academically, involved in community service, and demonstrates potential to become an amazing nurse.

Entrepreneur Nurse - Nurse owns a successful healthcare-related business, serving their community, preceptor or mentor to other nurses.


Summary: Please include a summary of no more than 500 words of the way the nurse demonstrates and exhibits the behaviors that define the category in which they are nominated.