2026 MBA_Mary Barkey Clinical Excellence Endorsement Form

Mary Barkey Clinical Excellence Award_Endorsement Request

ENDORSEMENT FORM 2026
Mary Barkey Clinical Excellence Award Endorsement Instructions

You have been selected to provide an endorsement for a Mary Barkey Clincial Excellence Award nominee! Please complete the form below and click Submit when finished. Your responses will be included with the nominator/applicant’s submission and reviewed by the Awards Committee.

To ensure the nomination is eligible for consideration, all supporting documentation must be submitted no later than 11:59 p.m. (EST) on Monday, December 1, 2025.

When completing this form, please be specific describing exemplars in each area. For additional guidance, refer to the Submission Tips Sheet before submitting your responses.

⚠️ Important: To maintain the integrity of the review process, please do not include the nominee’s name or any other identifying information (such as workplace, city, or specific program names) in your responses. The Awards Committee reviews applications in a blinded format, and inclusion of identifying details may affect eligibility..

If you have any quesitons please contact Awards Committee with any additional questions.
Nominee/applicant:*

First NameLast Name
Nominator/applicant:*

First NameLast Name
Endorser Name:*

First NameLast Name
Endorser's Title:*
Endorser's Place of Employment:*
Endorser Email Address:*
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Exemplars of Criteria

Mary Barkey Clinical Excellence Award

Be specific in describing exemplars in each area. .
A. Demonstrates the ability to work collaboratively with other health care team disciplines in the delivery of patient care which results in positive outcomes for patients. Please provide a minimum of two behavioral examples of how the nominee works collaboratively with other health care team disciplines in the delivery of patient care, explain how this behavior results in positive outcomes for patients and describe those outcomes.*
B. Models exemplary practice of child life through critical thinking, inquiry, evaluation, and a commitment to continuous improvement. Please provide a minimum of two behavioral examples of how the nominee models critical thinking, inquiry, evaluation and commitment to continuous improvement.*
C. Demonstrates competence and an ability to provide effective interventions in a variety of situations. Please provide a minimum of two examples of how the nominee demonstrates expertise in specific areas of child life practice and describe effective, evidence based interventions used by the nominee in a range of situations.*
D. Models child life practice and team behaviors that acknowledge and respect the diversity of patients/families and members of the health care team. Please provide a minimum of two behavioral examples of how the nominee models child life practice and team behaviors that acknowledge and respect diversity.*
E. Demonstrates strong professionalism and values-driven interactions that include clear, supportive, boundaries-sensitive, and professional relationships with patients and families. Please describe the nominee’s strong professional values. Provide specific examples of how the nominee’s values drive his/her interactions. Please include an example that demonstrates the nominee's professional relationships with other members of the health care team.*
F. Exercises sensitivity to the individual circumstances of patients/families and provides supporting and nurturing care. Please describe behaviors that demonstrate sensitivity to patient/family circumstances and provide supporting and nurturing care. What does the nominee do? How does the child/family respond?*
G. Embraces and models the core concepts of family-centered care, including information sharing to support patient/family participation, collaboration and involvement in their care. Please provide a minimum of two behavioral examples which demonstrate a patient- and family-centered care philosophy. How did the nominee share information and support a family in participation and decision making? How does he/she support families in their primary roles as caregivers, and supporters of their children and their continued participation in their child’s care?*
H. Participates in the development and incorporation of evidenced-based practice. Please provide a minimum of two behavioral examples that highlight the nominee's contributions, which may include current or past participation in research or writing project, or applying an evidence base in his/her practice. How has the nominee changed his/her practice over time to include the use of strategies based on evidence?*
I. Mentors new child life specialists and students in developing child life competencies and supporting the effective transition to professional practice. Please provide a minimum of two behavioral examples of how the nominee provides mentoring support to new child life specialists and students. How does he/she help new child life specialists to develop competence? How has that resulted in an effective transition to professional practice for the student/new child life specialist?*
J. Actively participates as a member of the Association of Child Life Professionals. Please explain how the nominee engages with the Association of Child Life Professionals. How does he/she use membership resources? How does he/she contribute to the growth of the profession through committee membership and work? What contributions has the nominee made to the profession overall?*
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Mary Barkey Clinical Excellence Award_Endorsement Request