2021 Nomination for Clinical Practitioner of the Year

PSRC Future Leader Practitioner of the Year Award - Nomination Form
The PSRC is seeking nominations for the 2024 Future Leader Practitioner of the Year award. This award identifies and recognizes a PSRC member who displays significant contribution to their personal & professional development, departmental improvement, and/or the field of respiratory care.

In order to be eligible for nomination, the nominee must meet the following criteria:

1) Be an active AARC / PSRC member.

2) Hold an active PA respiratory license.

3) Currently practice in Pennsylvania and spend at least 50% of his/her professional time spent with direct patient care

4) Must have < 5 yrs. experience as a licensed respiratory care practitioner.

5) Registered Respiratory Therapist (RRT) credential awarded by the NBRC.

To view the full criteria for this award, click here.

AWARD SUBMISSIONS DUE BY FEBRUARY 28, 2025.
Nominator:

Person submitting the nomination
Full Name*

First NameLast Name
Company*
Position*
E-mail*
example@example.com
Phone Number*
AARC #
Nominee Information

Please indicate details about your nomination
Name of Nominated Person*
E-mail Address (if known)
example@example.com
Phone Number (if known)
Place of Employment*
Job Title*
PA Licensure is in good standing:

YesNo
Professional Credentials:

CRTRRTACCSNPSCPFTRPFTSDSRPSGTAE-CRNMDOther
Education Credentials:

ASAABSBABSNMBAMSMEdPhDOther
Years in the Profession:

0 - 2 Years3 - 5 YearsUnknown
AARC # (if known):
Percentage of time spent with direct patient care:
PSRC Involvement (Board of Directors, Committee Involvement):
AARC Involvement (HOD, Committee Involvement):
Involvement in promoting public awareness of respiratory care through health fairs, community outreach events, school recruitment, etc. :
Actively participates in a formal mentoring program:
Presentation of evidence-based respiratory care, education, leadership, and/or research in the form of public or virtual speaking engagement:
Participation in collaborative and multidisciplinary committees within their organization that promotes patient safety, quality, experience, and/or growth:
Has documented direct contribution to the quality and safety of patient care delivered by respiratory care:
Has documented significant contribution to the education, direction, and future growth of respiratory therapists and/or the respiratory care profession:
Has published material in a peer reviewed journal in the last 18 months:
Please feel free to attach any supporting documentation you feel is necessary, for example Curriculum Vitae

Cancelof
Additional comments for consideration:
Should be Empty:

PSRC Future Leader Practitioner of the Year Award - Nomination Form

Nominator:

Nominee Information