NURSE OF THE YEAR’ 2012

6th Annual Nurses Gala hosted by Good Samaritan Health Clinic of Pasco Inc.

- OFFICIAL NOMINATION FORM -

It’s that time of year to nominate the “Best of the Best”

If you are thinking about nominating a Nurse, start by thinking about someone who views “Nursing as their life’s passion”. An RN or LPN who not only is an outstanding employee and/or colleague but the Nurse that maintains the highest standards in everything they do.

• That Tireless Teacher - who has provided a positive influence through support and the mentoring of other Nurses
• That Shining Star - who has made significant professional and/or voluntary contributions to the community.
• That Compassionate Soul – who demonstrates excellent care and compassion to everyone they encounter.

Nurses can be nominated by anyone and ballots will be accepted through April 11th.

Your finalist will be honored at the Nurses Gala, May 11, 2012 at Spartan Manor. All

proceeds will benefit the Good Samaritan Free Health Clinic.

Nominee:___________________ Nominated by:__________________________

Place of employment ______________________ Contact #___________________

In 100 words or less please describe why you believe your nominee should receive this award.

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For your convenience, you can fax your ballot to ( 727 – 848 -7890 )

Or e-mail to: This e-mail address is being protected from spambots. You need JavaScript enabled to view it