PANA Annual Awards Nomination Form


2012 Official Awards Nomination Form

  • Outstanding Student of the Year
  • Didactic Instructor of the Year
  • Clinical Instructor of the Year
  • CRNA Clinician of the Year
  • Program Director of the Year

Nomination Deadline: February 20, 2012

This award nomination must be accompanied by:
  • 3 letters of support
  • The nominees Curriculum Vitae
Note: For the educator awards, one of the letters of support must be from students.

Please email the accompanying support materials to info@PANA.ORG or mail to the PANA office: 17 South High Street, Suite 200, Columbus, OH 43215

Your information will not be deemed submitted until all supporting literature has been received.

All information received will remain confidential. The Student Activities Committee of the PANA will recommend the award recipients for the Clinical and Didactic Educators, Program Director, and Outstanding Student to the PANA Board for approval. The PANA Executive Board will select the Outstanding CRNA Clinician.

Enter Your Nominee Information
Name:
Address:
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Zip Code:
Nominees Present Position:
Present Position:
Address:
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Nominated By: (Enter your name and address)
Name:
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Award Selection and Support:
Please select the award you wish to nominate this person for:   

Describe this individual’s contributions to the profession of nurse anesthesia:

Why should this individual receive the award?