Western Institute of Nursing
2010 Awards Nomination Form

 

Scroll down to the Nomination Form found below to nominate for the following awards:

 

To nominate someone for more than one award, you must submit a separate form for each award - do NOT use a single submission for multiple awards.

 

The deadline for submitting all nominations is 5:00 pm, Monday, November 2, 2009 (Pacific time).

Please check the award this nomination is for [please check only one]:




: This nomination is for an or a


NOMINEE

Telephone:


PERSON WHO IS SPONSORING THE NOMINEE:

Telephone:


SUPPORTING NOMINATOR #1 (required for all awards):

Telephone:


SUPPORTING NOMINATOR #2 (required for the Anna M Shannon Mentorship Award; the Jo Eleanor Elliott Leadership Award; and the WIN Emeriti Award):

Telephone:


Please submit the required supporting documents electronically to win@ohsu.edu.