Type of Excellence Award you are nominating the person for:
(If nominee is eligible in more than one category, please indicate by selecting all of the appropriate choices below.)

Number of Years the Nominee has been a Member of OAAPN:

OAAPN Region, Nominee is a Member of:


Offices held in OAAPN:



Other forms of service to OAAPN:



How many years and in what capacity do you know the nominee:



Please discuss the contributions the nominee has made to
advanced practice nursing. Discuss contributions that would
make the nominee an outstanding candidate for the award you
have selected.



Explain how the nominee has been innovative in his/her area of
expertise:



Explain how the nominee influences other nurses to participate in
his/her areas of expertise:



Explain how the nominee demonstrates professional qualities in
nursing:



Explain how the nominee provides for self-growth and
development, and how the nominee mentors others:




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