Preceptor Award Nomination Form

In order to be considered for this award, nominees should meet the following criteria Demonstrates advancing nursing education. Distinguished themselves through precepting. To qualify for this award, nominees shall have recently precepted for the UNM College of Nursing.

Nominee's Name

Professional Title

Telephone Number

Email Address

Street Address

City

State

Zip Code

Degree(s) - Institution and Year

Does the nominee precept for undergraduate or graduate programs/students?

Please respond to the following questions and provide specific examples in each response. All answers must be a minimum of 250 words.

How does the nominee influence the advancement of nursing education?

Please provide specific examples.

How does the nominee distinguish him/herself though precepting, clinical practice and/or leadership?

Please provide specific examples.

Tell us about yourself

Nominator's Name

Are you an alumna/us?

Nominator's Professional Title

Nominator's Employer

Nominator's Daytime Phone

Nominator's Email

Nominator's Street Address

Nominator's City

Nominator's State

Nominator's Zip Code

Send me a copy of my responses

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