Nursing Excellence Award Nominations

Complete all information requested. View all submission requirements here.

Completed Application must be received no later than March 21, 2025

The Awards Committee will not consider incomplete applications.

Fill out the application below OR print the application (located via at bottom of this page)
and mail to the address within the document.

I nominate the following individual for the PNA Nursing Excellence Award:

Nominee

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address

Phone

(###)

###

####

Nominated for

Clinical Excellence

Administrative Excellence

Educational Excellence

Rising Star

Are you (the nominator) a member of the PNA?

membership is not a requirement to make a nomination

Yes

Is the nominee a member of the PNA?

membership is not a requirement for nominees

Yes

Occupational Title

Employer

Nominee Phone

(###)

###

####

Your name (who is submitting the nomination?)

Your Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Your Phone

(###)

###

####

Signature

(this electronic signature acknowledges your submission)

If you prefer to print this application and mail it in, click below. If you filled out/submitted the form above you do not need to mail anything in.

Print application