2008 Nurse of the Year

Nomination Form

Name of the Nominee:____________________________________________

Agency/County of Employment:____________________________________

Position:_______________________  Years of Public Health Service:_______

Write a summary why you believe this nurse should be selected as “Nurse of the Year”.  Note Activities and career highlights, including membership in professional organizations such as WNCPHA.  Additionally, you may submit up to three letters or statements of support.

Person submitting the nomination:___________________________________

Contact information:  Phone #:_______________________Email:___________________________________

Return form to:      

Marian Hibbitts, Catawba County Health Department

            3070 11^th Ave. Dr. SE

           Hickory, NC 28602

            mhibbitts@catawbacountync.gov

            Phone:  828-695-5831   Fax:   828-695-4437

In order to be considered your nomination must be received no later than: March 1, 2008

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WNCPHA Nursing Service Section

2008 Officer/Committee Volunteer/Nomination Form

 Complete the following information if you would like to volunteer and/or nominate a Nursing Service Section member for 2008 office.

I am currently serving as ______________________________, and would be willing to serve again if elected.

I am interested in serving as an Officer in the Nursing Service Section.

Chairperson _____

Vice-Chairperson _____

Secretary _____

Treasurer _____

 I am willing to serve on the following Committee:

Program _____

Awards _____

Nominating _____

Audit _____

I would like to NOMINATE* __________________________(Name of person) to serve in the Office of _______________________ in the Nursing Service Section.

I would like to NOMINATE* __________________________(Name of person) to serve on the _________________________Committee.

 *Person nominated will be contacted by the Nominating Committee and must agree to the nomination. 

*Please provide contact information for Nominee if known.

Public Health Nursing issues that I am especially concerned about include the following: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Name (person completing form)  _______________________________________

Agency  __________________________________________________________

Address  __________________________________________________________

Phone #  __________________________________________________________

Email  ____________________________________________________________

Return to:  Marian Hibbitts @ Catawba County Public Health,

                       3070 11^th Ave Dr SE, Hickory, NC 28602, or

                mhibbitts@catawbacountync.gov, or fax:  828-695-4437.

                                        By March 1, 2008