UNCW School of Nursing OUTSTANDING ALUMNI NOMINATION INVITATION 2016 Please consider nominating a registered nurse who graduated from the UNCW School of Nursing for the fifteenth Outstanding Alumnus Award. The person selected will take his/her place of honor at the annual Nurses Day Celebration on May 9, 2016 and be invited to join us at the Graduation Recognition and Awards Ceremony of our senior students on May 6, 2016. This individual will be recognized as a representative of the agency where employed. If you know of a nurse alumna who graduated in 2011 or prior and exemplifies the spirit of excellence, please submit that name and qualifying data on the nomination form below. This form is also located on the School of Nursing website at the link below: http://www.uncw.edu/son/documents/UNCW2016OutstandingAlumniNomination.pdf Submit by April 1, 2016 to: Dr. Laurie Badzek, Director UNCW School of Nursing 601 South College Road Wilmington, NC 28403-5995 FAX or email to Debra Simpson FAX: 910-962-3723 Email: simpsond@uncw.edu UNCW School of Nursing OUTSTANDING ALUMNI NOMINATION 2016 Criteria: 1. Leadership in any of the following: o A direct patient care role (including preceptor, mentor, guide roles) o Guiding/managing others to improve care o Applying best-practices and evidence to care standards o Education of nurses o Research and scholarship in nursing 2. Contributes to the profession of nursing o Leadership in professional associations o Scholarly publications/writings/presentations about the value of nursing 3. Active in improving the health and wellbeing of the community I nominate the following Registered Nurse, a UNCW School of Nursing graduate as the 2016 Outstanding Alumnus. 1. Name of the registered nurse alumnus whom you wish to recommend: Address: Telephone: Email: Year of Graduation: (Nominees must have graduated in 2011 or prior) 2. Area of Practice 3. Position Title and Institution where employed: 4. My nominee demonstrates leadership in the following ways (criteria 1, above): 5. My nominee contributes to the profession of nursing in the following ways (criteria 2, above): 6. My nominee is active in promoting the health of wellbeing of the community in the following ways (criteria 3 above): 7. Please add any other activity demonstrated by this nurse which you believe to be exemplary. Recommendation submitted by: Name: Address: Telephone number(s): Email Address: Thank you for your nomination. Submit by April 1, 2016 by mail, fax or email US Mail Dr. Laurie Badzek, Director UNCW School of Nursing 601 South College Road Wilmington, NC 28403-5995 FAX or email to Debra Simpson FAX: 910-962-3723 Email: simpsond@uncw.edu