IASN School Nurse and School Nurse Administrator of the Year

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Upon receipt of this nomination, all qualifying nominees will be notified and provided with an opportunity to submit their curriculum vitae and statement of school nursing contribution. These documents will be used to judge nominees based upon School Nursing: Scope and Standards of Practice (NASN and ANA, 2011) as well as the Framework for 21st Century School Nursing Practice.

For questions, contact Joy Sunday at jsunday@valpo.k12.in.us .

Nominee's Name & Credentials *

Nominee's Home/Cell Telephone *

Employer's Name *

Employer's Street Address *

Employer's City *

Employer's Zipcode *

Nominee's Work Telephone *

Name of Principal or Supervisor *

Nominee's Work Email Address *

Nominee's Position (Title) *

Number of years nominee has held this position *

Time nominee devotes to direct nursing care vs. supervisor/coordinator *

Less than 50% of time is spent providing direct care and more than 50% of time is spent as supervisor/coordinator

50% or more of time is spent providing direct care and less than 50% of time is spent as supervisor/coordinator

Number of years worked in the field of school nursing *

Number of students served *

Grade levels served in current position *

Length of NASN/IASN membership (if known)

In 450 words or less, describe the nominee's significant contributions to advancing excellence in school nursing practice and leadership in school health. *

Name of Nominator *

Nominator's Telephone *

Nominator's Email Address *

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