EXCELLENCE IN NURSING RECOGNITION
DECEMBER AWARD ENTRY FORM
CATEGORY (check one only)
Nursing Research
Nursing Mentorship
Nursing Practice
Outstanding Student Performance
Name of Nominee:________________________________________________________
Address:________________________________________________________________
City:__________________________ State:_________________ Zip:________________
Phone--Day: (
)_____________________ Night: (
)_________________________
Yes … Chapter:_____________________________
No
CURRICULUM VITAE OUTLINE
Education:_______________________________________________________________
Sigma Theta Tau Member:
________________________________________________________________________
_______________________________________________________________________.
Certifications:____________________________________________________________
________________________________________________________________________
_______________________________________________________________________.
Achievements/Honors:_____________________________________________________
________________________________________________________________________
_______________________________________________________________________.
Professional Memberships:__________________________________________________
________________________________________________________________________
_______________________________________________________________________.
Unique Contributions that qualify the Nominee for this award:______________________
________________________________________________________________________
_______________________________________________________________________.
Nomination Submitted By:
Name:__________________________
Address:________________________
_______________________________
Phone:__________________________
Send Entry To:
Robin Lawson
USA College of Nursing
307 North University Blvd.
HAHN Room 4058
Mobile, AL 36688
or rlawson@usouthal.edu
Are Supporting Letters Attached? Yes … No … Nomination Due: November 15