Nursing Student
Advisor of the Year
Title/Position: ______________________________________________________________________
School: ___________________________________________________________________________
School Address: ____________________________________________________________________
City: _____________________________________ State: ____________ ZIP: ______________
Phone: ______________________________________________________________
Number of Years Teaching: _____________________________________________
Professional Education (list names of schools and degrees):
Classes (lecture, clinical, lab) you currently teach:
Other schools where you have taught:
THE FOLLOWING WILL BE USED TO EVALUATE THE NOMINEE:
List the professional organizations to which you belong:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
List nursing organization offices held or committees on which you have served on in the past two years:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
List involvement with student groups in the past two years:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
THE FOLLOWING IS TO BE COMPLETED BY THE STUDENT WHO IS NOMINATING THE FACULTY ADVISOR:
Nominated by (name of school): _________________________________________________________
Contact student's name, address, and phone number:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
ESSAY TO BE WRITTEN BY STUDENT
Plese write an essay, no longer than two double-spaced, typed pages that address the following items.
The essay must explain how the nominee provides motivation and generates enthusiasm for student involvement and for the nursing profession.
Describe how the nominee exhibits and teaches professionalism.
Explain how the nominee encourages students to continue their education and professional involvement beyond graduation.
September 10, 2004
GANS Awards Committee
c/o Traci Steinhauser
1727 Country Park Way
Lawrenceville GA 30043
(404)432-7273
[email protected]