Colorado Springs Nightingale

~Online Nomination Form~

Call for Nominations Poster - HTML/PDF
Nomination Form - Online (see below - Colorado Springs AHEC only) or Printed form (For other AHECs or alternative method. Please mail to the appropriate AHEC coordinator.)

The statewide selection committee encourages your nominations of candidates for the annual Nightingale Awards. The Nightingale Awards were founded in 1985 to recognize excellence in human caring by Colorado registered nurses. The regional prestigious awards will be presented at a dinner held on Friday, March 12, 2010.

  • Nominee must be a Registered Nurse (RN) currently practicing in Colorado or retired from practice in Colorado.
  • Nominee may have been previously nominated and/or a finalist but may not be a previous recipient.
  • An initial letter of nomination and this form must be postmarked by Friday, December 4, 2009.

Our ability to contact your nominee is determined by the accuracy and completeness of the following information. (All nominees will receive a nominee packet that explains required support documentation.) Please type or print carefully.

Nominee:
(for the Colorado Springs AHEC)
*Name:
*Home Phone:
*Home Address:
*City: 
*State: 
*Zip:
*E-Mail :
*Nominee's Employer:
*Employer's Phone:
Employer's Address:
Employer's City: 
Employer's State: 
Employer's Zip:
Employer's Fax:
Employer's E-Mail :
* = required information
 

Nominator
*Name:

*Daytime Phone:
*Home Address:
*City: 
*State: 
*Zip:
*Fax:
*E-Mail :
* = required information

*Initial Letter of Nomination:

Please describe how your nominee demonstrates excellence in human caring in his/her professional practice, personal and community life. Please feel free to cite examples when caring made a difference and be specific.


Visual verification:
Type the black characters shown in the picture here:   

Joomla Professional Work