Form

Citation of Excellence Nomination Form

Peers or supervisors are encouraged to nominate a nurse who has demonstrated excellence in nursing for The ASNA Citation of Excellence Award. Nominees may be recommended at any time during the year.

The nominator or nominee does NOT have to be an ASNA member.
Your nomination form will be reviewed promptly and a certificate suitable for professional presentation, signed by the ASNA President, will be returned via mail to the nominating person.
The nominator and supervisor may present the award to the individual in a staff meeting or in a setting of their choice. It is appropriate that the supervisor make the presentation.
A portrait (headshot) of the individual may be emailed to ASNA after the presentation for acknowledgement in ASNA’s quarterly newspaper, The Alabama Nurse , sent to over 80,000 nurses in the state.

Information about the person BEING NOMINATED:

Name

First Name Last Name

Job Title

Place of Employment

Email (we may send them a congratulations email after they receive the award)

example@example.com

Reason(s) this individual is deserving of a Citation of Excellence (You may upload additional information below if needed):

Photo of nominee for the The Alabama Nurse

Upload additional information here (if applicable)

Nomination Approved by: (Supervisor's name & Title)

Information about YOU:

Name

First Name Last Name

Job Title

Place of Employment

E-mail

Phone Number

- Area Code Phone Number

Address where you would like the award mailed.

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country