HIV/AIDS CERTIFIED NURSE OF THE YEAR AWARD
HIV/AIDS Nursing Certification Board
Please consider nominating yourself or an ACRN/AACRN colleague for the HIV/AIDS Nursing Certification Board, HIV/AIDS Certified Nurse of the Year Award.
To be considered as a candidate for HIV/AIDS Certified Nurse of the Year Award by the HIV/AIDS Nursing Certification Board, the candidate must meet the following criteria:
1. Currently certified as an AIDS Certified Registered Nurse, or an Advanced AIDS Certified Registered Nurse;
2. Membership in the Association of Nurses in AIDS Care;
3. Demonstrated excellence in HIV/AIDS nursing;
4. Demonstrated leadership in ANAC or HANCB, or excellence as an HIV/AIDS nurse;
5. Demonstrated involvement in HIV/AIDS community activities, and
6. Fostered advancement of HIV/AIDS Certified Registered Nurses through sharing of expertise.
Type of Nomination:
self-nomination / nomination of an ACRN/AACRN colleagueDemographic Information of HIV/AIDS Certified Nurse of the Year Nominee:
Name
Address
City State Zip code
Phone: Home Work
Fax Email ANAC Membership #
Initial AACRN/ACRN Certification Date
Will candidate be attending ANAC conference? Yes No Don’t Know
Demographic Information of Person Nominating the Above Individual for HIV/AIDS Certified Nurse of the Year
Information is the same as above since this is a self-nomination
If the information is different than above, please complete the following information so that we may contact you for more information, if necessary.
Name
Address
City State Zip code
Phone: Home Work
Fax Email
Professional Experience of HIV/AIDS Certified Nurse of the Year Candidate
Please include a copy of the nominee’s resume with this application.
Number of years practicing HIV/AIDS nursing:
Highest Degree Completed
Diploma / Associates Degree / BS/BSN / BA/BS in another fieldMA/MSN/MN / MA/MS in another field / PhD / DNSc / MPH
DNP EdD
Other Certifications Held by Nominee
C / CS / NP / CCRNCEN / OCN/AOCN / Other
Current Position
Title Agency
Please highlight the following information about the nominated candidate for the HIV/AIDS Certified Nurse of the Year Award. Please limit each response to 200 words or less.
1. What is the nominee’s professional experience in HIV/AIDS nursing?
2. How has the candidate demonstrated clinical excellence in HIV/AIDS nursing?
3. What activities has the candidate been involved in that demonstrate leadership and
commitment to professionalism in HIV/AIDS nursing?
4. How has the candidate promoted certification as an HIV/AIDS Certified Registered Nurse?
Electronic Signature of Nominator Date
By July 31, 2016, please email the completed nomination forms, including the candidate’s resume as attachments to , or fax or mail them to the:
HIV/AIDS Nursing Certification Board
3538 Ridgewood Rd
Akron, OH 44333
(800) 260-6780
(330)-670-0109 Fax
NOTE: All current members of the HANCB and ANAC Board of Directors are ineligible to apply. Receipt of the Award does not include financial sponsorship to attend the ANAC Conference or the Award Ceremony to receive the award. The Award Winner will receive a plaque and recertification gift certificate.
Form Approved by HANCB MCF, April 2015