Nomination for Excellence in Rehabilitation Nursing
PLEASE PRINT
Information about the individual being nominated
Name: ____________________________________________________________________________
Home Address: _____________________________________________________________________
City, Zip Code: _____________________________________________________________________
Name of employer: __________________________________________________________________
City of Employer: ____________________________________________________________________
Position/Job Title: ___________________________________________________________________
I believe that this candidate should receive the award based upon the following:
The nominee need not be active in all of the areas identified below. This is meant to help you generate ideas. Self nominations are accepted.
PROFESSIONAL WORK ACOMPLISHMENTS
- Certification
- Recruitment of Nurses and/or rehabilitation nurses
- Committee/special project work, publications, program planning and/or program development
- Quality improvement, preceptor. Mentor, team player
WARN / ARN SUPPORT
- Membership Recruitment
- Conference attendance or participation as a speaker, planner/activity
- Newsletter contribution, past Board member
COMMUNITY INVOLVEMENT
- Promotion of rehabilitation outside of work environment
- Promotion and informing others about legislative and community issues related to rehabilitation nursing/nursing.
SPIRIT
- Describe how the nominee exemplifies the spirit and caring of rehabilitation nursing
Information about the person submitting the nomination:
Name: ____________________________________________________________________________
Address, Street, City, State, Zip: ________________________________________________________
Phone number: Home: ___________________________ Work: _______________________________
Place of Employment: ________________________________________________________________________
Describe reason for nomination below, attach additional pages as needed.
Submit application to:
Lynn Morgenstern
7801 Caldwell Court
Milwaukee, WI 53281/lemorgenstern60@yahoo.com