APRN Preceptor Award | 2026
Individual Nomination Form
Your Personal Information
Name
*
First Name
Last Name
University of Cincinnati Email
*
example@mail.uc.edu
Preferred Phone Number
*
Please enter a valid phone number.
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Nominee's Information
Nominee's Name
*
First Name
Last Name
Nominee's Email
*
example@example.com
Nominee's Home, Organization or Work Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Nominee's Job Title
*
Nominee's Employer
*
Start Date of Precepted Experience with Nominee
*
-
Month
-
Day
Year
Date
End Date of Precepted Experience with Nominee
*
-
Month
-
Day
Year
Date
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Describe how the nominee demonstrates a passion for and commitment to the role of preceptor. (Please provide specific examples.)
*
Describe how the nominee created a quality learning experience for you in the time this person served as your preceptor. (Please provide specific examples.)
*
Describe how your experience with this nominee as a preceptor has influenced your academic journey and your future role as an advanced practice nurse.
*
In a few words, how would you define the impact this precepted experience has had in your preparation as an advanced practice registered nurse? (This is optional and does not impact your nomination.)
Acknowledgement
*
I acknowledge that my responses could be used in future University of Cincinnati College of Nursing communications.
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