Nominate a Great Nurse 2010

Nominations will only be accepted in the context and format presented here. Those that do not follow this format will not be considered. Nominees must meet the stated criteria and the form must be submitted online or postmarked no later than January 1, 2010 to be considered. Resumes are not necessary, but please include specific examples of how your nominee meets the criteria (for examples of previous winning nominations, click here). The selected 100 Great Iowa Nurses will be announced on the Great Nurses website on Monday, March 1, 2010. The honorees will be recognized at a special celebration in Des Moines on May 3, 2010. Committee Chairpersons and members of the Nomination Committee are ineligible. Nomination materials will be shared with nominees and the media, as appropriate.

Selection Criteria:

Current Iowa Registered Nurse License (licensure will be checked with the Iowa Board of Nursing)
Has practiced nursing for a minimum of three years
Significant contribution to the profession of nursing

Nominee

First Name*

Last Name*

Home Address*

City*

State*

Zip*

County

Home Phone Number (with area code)*
Format: (999) 999-9999

E-mail Address

Nominee's Employer:

Employer*

Address*

City*

State*

Zip*

County

In which type of health care setting does the nominee practice?

Inpatient Care Unit
Emergency
Critical Care
Long-Term Care
Home Health Care / Visiting Nurse
School Nursing
Education
Clinic/Doctor's Office
Other (please specify)
If you selected other, please specify:

Which best describes the role of the nominee?

Director of Nursing
Manager/Supervisor
Nurse Practitioner
Educator
Bedside/Staff Nurse
Other (please specify)
If you selected other, please specify:

First Name*
Last Name*
Home Address*
City*
State*
Zip*
County
Home Phone Number (with area code)*	Format: (999) 999-9999
E-mail Address