IANANT Advance Practice Provider of the year award nomination form 2025 Nomination Criteria Eligibility: 1. Current IANANT membership. 2. Current role as Nurse Practitioner, Clinical Nurse Mid-Wife, Clinical Nurse Specialist and Certified Registered Nurse Anesthetist.Nominee's Name(Required) First Last Nominee's Credentials(Required)Nominee's Email(Required) Nominee's Phone(Required)Nominee's Title/Position(Required)Nominee's Area of specialization(Required)Nominee's Current IANANT Membership status(Required)Select oneACTIVEINACTIVEDON'T KNOWTexas Advanced Practice Nurse License(Required)Select oneNPCNSCRNACNMOTHERTexas Advanced Practice Nurse License Number(Required)Texas Advanced Practice Nurse Years in Nursing(Required)Nominee's Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Nominator's Name(Required) First Last Nominator's Credentials(Required)Nominator's Email(Required) Nominator's Phone(Required)Nominator's Title/Position(Required)Nominator's Area of specialization(Required)Nominator's Current IANANT membership status(Required)Select oneACTIVEINACTIVEDON'T KNOWNominator's Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code 1. Clinical Excellence & Impact in Advanced Practice Nursing : Describe how the nominee demonstrates clinical expertise and has positively impacted patient care and nursing outcomes through their advanced practice. Include specific examples of evidence-based practices they have implemented to improve care and outcomes (max 500 words).(Required)2. Mentorship & Professional Development: Explain the nominee’s commitment to mentoring and professional development in the advanced practice nursing field. Provide examples of how they have supported and promoted the growth of other nurses, including students and early-career professionals (Max: 400 words)(Required)3. Advocacy & Contributions to the Nursing Profession : Describe how the nominee advocates for the nursing profession, especially within their advanced practice role. Highlight their involvement in local, state, or national initiatives, policy changes, community outreach, or leadership in professional organizations (Max: 400 words)(Required)4. Innovation & Leadership in Advancing Nursing Practice : Detail the nominee’s contributions to innovation in nursing, particularly in the advanced practice realm. How have they adopted new technologies, conducted research, fostered interdisciplinary collaborations, or introduced new models of care? Include their vision for the future of nursing and healthcare (Max: 400 words)(Required)5. Community Involvement : Describe the nominee’s engagement in community service, volunteer work, or public health initiatives. How have they contributed to the well-being of their community, promoted health education, or addressed healthcare disparities (Max: 300 words)(Required)Supporting Documents (Optional) Please include any of the following documents (optional): ☐ Resume/CV of Nominee ☐ Letters of Support (Maximum of 2) ☐ Additional Supporting Materials (Awards, Publications, Media Mentions, etc.)FileMax. file size: 128 MB.If you have any questions, email @ ianantscholarship@gmail.comCertification & Submission: By submitting this nomination, I certify that all the information provided is accurate to the best of my knowledge. Nominator’s Signature(Required)CommentsThis field is for validation purposes and should be left unchanged.
