Royal College of Nursing – Representative of the Year Awards 2016 – Nomination form
RCN Representative of the Year Awards 2016
Nomination form
Section 1: award category
Please select the award category you are nominating for (select one only):
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Learning representative of the year
Safety representative of the year
Steward of the year
Please note that only accredited RCN representatives are eligible for an award. For further information, please
refer to www.rcn.org.uk/repsoftheyear for supporting information.
Section 2: details of the representative you wish to nominate
(Please include as much of the information below as possible)
Name:
RCN membership number (if known):
RCN country/region or branch:
Job title:
Address:
Postcode:
Telephone (home):
Telephone (work):
Telephone (mobile):
Email address:
How do you know the nominee?
Section 3: your details
Name:
Address:
Postcode:
Telephone:
Email address:
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Are you an RCN member?
Yes
Are you an RCN staff member?
Yes □
No
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No □
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Royal College of Nursing – Representative of the Year Awards 2016 – Nomination form
Section 4: supporting statement
Use this section to outline why you are nominating the representative for this award.
You should write between 200 and 300 words in total.
We have included some questions below to help you structure your statement:
1. Describe how your nominee made a difference in the workplace or to other members
– give specific examples, including any special initiatives, of what and when they did it.
2. What were the benefits of what they did – either to the individuals who they represented,
or to the workplace as a whole?
3. What was special about the way in which they did this – for example, what personal
qualities did they exhibit and how did they go about it?
4. Did others learn from what they did, and has anything changed in your/their
workplace more widely because of it?
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Royal College of Nursing – Representative of the Year Awards 2016 – Nomination form
Section 5: where did you hear about this award?
Please mark all those relevant:
Activate magazine
Bulletin magazine
RCN event or conference
Facebook
Twitter
RCN email
RCN website
Other (please explain):
Regional communications
RCN representative
RCN staff member
RCN staff intranet
Poster
Flyer
Letter
Section 6: submitting your nomination
Please return your entry by 5pm on Friday 1 April 2016
Please send this nomination form to
RCN awards – representative of the year
Governance Support Team
Royal College of Nursing
20 Cavendish Square
London W1G 0RN
Or email the completed form to: governance.support@rcn.org.uk
Telephone: 0207 647 3644
Please visit www.rcn.org.uk/repsoftheyear for more information.
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