2017LLS-Hematology-OncologySocial Worker of the Year Award

Nomination Form

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Individual Completing Form (all fields in bold are required)

Name
Street Address
Institution/Program
Relationship to Nominee
Address 2
City
State/Province
ZIP/Postal Code
Country(leave blank if USA)
Daytime Phone (###-###-####)
Email Address

Nominee (all fields in bold are required)

Name
Credentials/Professional Degree
Title
Institution/Program
Street Address
Address 2
City
State/Province
ZIP/Postal Code
Country(leave blank if USA)
Daytime Phone (###-###-####)
Fax(###-###-####)
Email Address

About Nominee’s Work and AOSWInvolvement

Current position of nominee (brief description of position):

Years in position: ______

Total years in oncology social work: ______

Focus of practice: (e.g. clinical, education, administration, research, adult, pediatric, inpatient, outpatient, etc.)

AOSW member since (if known) : ______

AOSW or other Oncology Social Work activities:

Provide responses to the following (limit each to 1750 characters, approx. 250 words or less)

1.How has the candidate demonstrated professionalism, integrity and commitment to oncology social work? Describe how these qualities have influenced the delivery of patient care services.

2.Describe how candidate’s professional conduct serves as a model for the profession of oncology social work. Include collaborative/negotiation skills within the health care setting, the multidisciplinary team, and/or those that demonstrate applicant’s impact on programs, community service or agencies.

3.Discuss the candidate’s knowledge of community resources and ability to advocate for meeting the unmet needs of blood cancer patients and their caregivers. Examples may relate to concrete service needs or program/policy development.

4.Describe the candidate’s ability to translate knowledge of psychosocial issues of blood cancer patients and their caregivers through supervision, educational activities and presentations. Examples may include skills in the supervision of clinical work and/or actual presentations.

5.How has the candidate contributed to the field of oncology social work?

6.What additional qualities does the candidate possess which make him/her uniquely qualified to receive this award?

Thank you for completing this nomination form for the LLS-Hematology-Oncology Social Worker of the Year Award.

Please save the completed PDF file to your computer and email the following items as attachments to AOSW Member Services Manager at .

  • Complete PDF Application
  • Nominee’s resume or curriculum vitae
  • Letters of support (minimum of two, no more than four) addressing criteria for the appropriate award from other social work professionals, co-workers, hospital administrators, or community agency representatives

Submission deadline: February 28, 2017