Distinguished Alumni Awards Nomination Form

Distinguished Alumni Awards Nomination Form | Due January 31
Nominee Information
Nominee Full Name*

First NameLast Name
Nominee CUSON Degree (if applicable)
Nominator Information
Nominator Full Name*

First NameLast Name
Nominator Affiliation*
Nominator E-mail*
Nominator Phone Number*

Area CodePhone Number
Award Information
Distinguished Alumni Award Criteria

The Nominee must meet the four general criteria listed below, in addition to the specific criteria for the award.
1. Has made a significant impact on the profession.
2. Is an innovator in professional endeavors.
3. Is viewed as an outstanding nurse by peers.
4. Has functioned as a mentor in facilitating the growth and future development of nurses within the profession.
Please indicate category of award for which you are nominating*

Nursing PracticeNursing ResearchHealth PolicyNursing EducationNursing AdministrationDistinguished Career in NursingEmerging Leader in NursingIn Memoriam for Lifetime AchievementNeighbors HumanitarianHonorary (non-alumni)
Supporting Documentation:

Only the information submitted will be the basis for award selection. All documents should highlight and explain how the nominee meets the general and specific award criteria.
- Nominator letter – include a detailed description of your nominee’s accomplishments.
- Additional letters of support – up to three letters of support (not including your nomination letter).
- Nominee resume/CV
- Other supporting documentation (selected publications, research, presentations)
Attach supporting documentation (may submit multiple files)*

Upload Documentation

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Checklist for nominator - the nomination should include:*

Nominator letterAdditional letters of supportNominee resume/CVOther supporting documentation
Incomplete applications will not be considered for review.
Should be Empty:

Distinguished Alumni Awards Nomination Form | Due January 31