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| Georgia Association of Nursing Student Emily McNelley - Member of the Year Award |
| Chapter Name: __________________________________________________________________ School Name: ___________________________________________________________________ School Address: _________________________________________________________________ City: ______________________________ State: _______________ ZIP: _______________ Phone: _________________________________________________ Nominee: _______________________________________________________________________ Chapter President: _______________________________________________________________ Chapter Advisor: ________________________________________________________________ THE FOLLOWING IS FOR THE NOMINEE TO COMPLETE: (Include another sheet of paper for additional space) Activities/Honors received: Comment on what you have done to help improve your chapter (include specific activities): Comment on your community involvement and awareness of issues involved in nursing (i.e. community projects, participation in state and national convention, etc.). Comment on how you see nursing today and what needs to be done to improve the nursing field in the future: |
| All applications must be received by September 10, 2004 |
| I hereby certify that all information and statements made in this application are complete and accurate. |
| Signature: _____________________________________ Date: ________________________________ Chapter Presidents' Signature: _______________________________________ Chapter Advisors' Signature: ________________________________________ |
| Please send the complete application & attachments to: GANS Awards Committee c/o Traci Steinhauser 1727 Country Park Way Lawrenceville GA 30043 (404)432-7273 [email protected] |