2014 Nurse of the Year Nomination Form
Thank you for your interest in nominating a candidate for the 2014 Nurse of Year. To nominate a candidate, please fill out the information below.
Your Contact Information
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First Name
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Last Name
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Address 1
Address 2
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City
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State
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Postal Code
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Phone
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Email Address
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Would you like to receive notification of upcoming LLS events?
Yes
No
Nominee's Contact Information
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First Name
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Last Name
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Title
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Employer
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Address 1
Address 2
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City
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State
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Postal Code
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Phone
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Email Address
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Privacy Option: Would you like to keep your identity undisclosed to the nominee.
Yes
No
Please answer the following questions:
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1. What is your specific relationship with the nominee?
0/350 words
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2. How long have you known or worked with the nominee?
0/350 words
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3. How does this nurse stand out among other nurses? How has she/he made a difference in patient outcomes, contributed to superior patient care and/or high-quality nursing practice.
0/350 words
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4. Provide specific examples of how the nominee made a difference in the life of a hematology/oncology patient and/or caregiver.
0/350 words
5. Tell us anything else that you thnk we should know.
0/350 words
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Indicates Response Required
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