Award of Excellence Nomination Form

Each nomination must include a written statement of support (minimum of 500 words) describing why this nominee deserves this award. Be clear and specific; support your statement with examples of how the nominee demonstrates exemplary levels of knowledge, skill, judgment (competence), compassion, professionalism, leadership, communication, and collaboration. You should be sure to provide details on how your nominee meets the nomination criteria for the selected award.

Close your written statement with an example of how the nominee promotes excellence and advances the practical nurse profession.

The College may contact you or the nominee for further information and/or clarification.

If you have any questions regarding the nomination process, please contact the College at 902-423-8517 (toll-free within Nova Scotia: 1-800-718-8547) option 3 or 4 or by email at practiceconsultant@clpnns.ca.

Name of Nominee:

The nominee's manager will be contacted to verify eligibility for nomination.

Place of employment:

Nominator:

Email Address*:

Phone Number*: HomeCellWork

Nominee's Primary Manager*:

(*For those nominees who are retired, please indicate most recent manager.)

Work Email Address*:

Work Phone Number*:

Written Statement of Nomination

Describe why you feel the nominee deserves the Award of Excellence and how they meet the award selection criteria. Nominations must be a minimum of 500 words.

Signature

My signature indicates that my statement of nomination is true and accurate.

e-Signature*:

Date*:


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Before you submit your nomination…

  • Have you made it clear how the nominee meets selection criteria?
  • Is all required contact information clear and accurate?
  • Not able to use the form above? Download the PDF version: Award of Excellence Nomination Form