2021 Nomination for Clinical Practitioner of the Year

PSRC Leadership Practitioner of the Year Award - Nomination Form
The PSRC is seeking nominations for the 2025 Leadership Practitioner of the Year award. This award identifies and recognizes a PSRC member who has distinguished themselves throughout the past year as leader in the respiratory profession and displays leadership qualities that sustain a model of continuous improvement.

In order to be eligible for nomination, the nominee must meet the following criteria:
- Be an active AARC / PSRC member.
- Hold an active PA respiratory license.
- Currently practice in Pennsylvania and spend at least 50% of his/her professional time managing and leading people.
Leadership Practitioner
- Displays significant contributions to the leadership and development of the field of respiratory care.
- Displays leadership qualities that sustain a model of continuous
  improvement.
- Must spend >50% of professional time managing and leading people.
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NOMINATIONS DUE BY FEBRUARY 28, 2026
Nominator:

Person submitting the nomination
Full Name*

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

Please indicate details about your nomination
Name of Nominated Person*
E-mail Address (if known)
example@example.com
Moblie 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:

1-4 Years5-9 Years10-14 Years15-19 Years20-24 Years> 25 YearsUnknownOther
AARC # (if known):
Percentage of time spent managing and leading respiratory care practitioners & other healthcare professionals:
Honorary Fellowships (FAARC, FCCP, FACHE ect):
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, example curriculum vitae.*

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Additional comments for consideration:*
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PSRC Leadership Practitioner of the Year Award - Nomination Form

Nominator:

Nominee Information