Awards Nomination Form - Canadian Association of Foot Care Nurses

I would like to nominate someone for the following award: *

CAFCN Award for Excellence in Foot Care Nursing

CAFCN Legacy Award

By submitting this nomination, I agree to the following or the following is true (please check them as you read through the list): *

I am not a member of the Awards Committee.

The nominee is not a current member of the CAFCN Board of Directors.

This nominee is a member in good standing with the CAFCN.

This nominee holds a valid nursing license and is in good standing with their regulatory body.

I am not nominating myself.

Nominator

Name *

First Name of Nominator

Last Name *

Last Name of Nominator

Nominator's Address *

Nominator's Email *

Nominator's Phone *

Relationship to the Nominee *

You will not be able to submit this form unless you are able to answer 'yes' to both of the questions below.

I agree to allow the nomination I have submitted to be shared publicly should the candidate be accepted as the recipient of the award. *

Yes

No

I have spoken to the nominee and they have agreed for the narrative to be shared publicly if accepted as the recipient of the award. *

Yes

No

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Nominee Candidate

Name *

First Name

Last Name *

Last Name

Address *

Email *

Phone *

Business Name (if applicable)

Business website (if applicable)

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CAFCN Legacy Award

Describe how the candidate:

Supports nurses striving to advance nursing foot care, knowledge and skills in their practice and community.
Demonstrates passionate about lifelong learning, sharing knowledge and practice techniques with peers to provide access to quality care to the community.
Pursues improving practice, immersed in research and higher learning.
Demonstrates a commitment to building nursing foot care community and connection.
Exceptional professional achievements, attributes, contributions, or service, as they relate to the above areas.

Examples of candidate criteria:

To support nurses striving to advance nursing foot care practice, knowledge and skills to their practice and community.
Passionate about lifelong learning, sharing knowledge and practice techniques with peers to provide access to quality care to the community.
Pursues improving practice, immersed in research and higher learning.
Demonstrates a commitment to building nursing foot care community and connection.
What other attributes has your nominee demonstrated to support this nomination?
Is there anything else about your nominee that you would like the committee to consider?

300 word narrative summarizing the above criteria *

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CAFCN Award for Excellence in Foot Care Nursing

Describe how the candidate:

Fosters involvement in the nursing foot care profession with peers and/or forming and engaging partnerships within the community.
Demonstrates excellence, creativity, and initiative in their business or profession.

Describe your nominee’s exceptional professional achievements and contributions or service, as they relate to nursing foot care.

Examples of candidate criteria:

Actively assist and provides leadership to peers to improve practice standards.
Provide valuable service to improve the quality of life for others in the community.
Outline the impact of the nominee on a local, regional, national, and/or international level.
What other attributes has your nominee demonstrated to support this nomination?
Is there anything else about your nominee that you would like the committee to consider?

300 word narrative summarizing the above criteria *

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References

Each nomination must include two (2) references to support the nomination. References may include, for example, a foot care nurse colleague, employer, professional colleague, a community, or a member of the public.

To add a new reference, click on 'Add'.

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References

Name *

First Name

Last Name *

Last Name

Address *

Email *

Phone *

Relationship to Nominee *

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