Massachusetts Coalition of Nurse Practitioners
MCNP Lifetime Achievement Award
The Massachusetts Coalition of Nurse Practitioners Lifetime Achievement Award recognizes nurse practitioners that have made significant lifetime contributions to nurse practitioner practice on a state (Massachusetts), national or international level. The Lifetime Achievement Award will be presented at the discretion of the Awards Committee at the Annual Awards Ceremony.
Eligibility/Selection Criteria
Nominator
- Must be a member of the MCNP
- Must submit a letter of recommendation.
- Must secure two additional letters of recommendation.
Nominee
- Is currently or has been a past member of the MCNP, or is an advocate for the MCNP
- Has made significant life long contributions to nurse practitioner practice, education, research or policy on a state, national or international level.
- Has inspired other nurse practitioners by the efforts they have put forth and the example they have set.
- Has exhibited creativity and innovation through activities that have enhanced the image of the NP on a state (Massachusetts) or national level.
MCNP Lifetime Achievement Award
Required Elements
Completed applications must be mailed by the required deadline. Nominators are responsible for assuring the application packet is complete prior to submission. Incomplete applications will not be considered.
The completed application should be sent in a single mailing and include:
Application Form
Nominee’s Resume/Curriculum Vitae (welcome but not required)
Nominator’s Letter of Recommendation that demonstrates evidence of the previously outlined criteria.
Two additional signed letters of recommendation *
Instructions for application completion & submission
Please complete all areas indicated with either text or check marks.
All applications must be submitted by March 31st.
Completed applications should be mailed to:
Chair, MCNP Awards Committee
C/O Peg Carlson
MCNP
P.O. Box 1153
Littleton, MA01460
*Each person writing a Letter of Recommendation should send it to the nominator who will be responsible for submitting the completed application in its entirety.
MCNP Lifetime Achievement Award
Application
Nominator Information
Name:
Address:
City/State/Zip:
Home phone (include area code):
Home Fax:
E-mail address:
Check box to confirm MCNP membership
Nominee Information
Name:
Address:
City/State/Zip:
Home phone (include area code):
Home Fax:
Nominee is a past or present member of MCNP: yes no
MCNP Lifetime Achievement Award
Nominator’s Letter of Recommendation*
Please describe the nominee’s significant lifetime contributions to nurse practitioner practice, education, research or policy on a state (Massachusetts), national or international level.
I certify that the information contained in this application is true and correct to the best of my knowledge.
Nominator’s Signature:
*Maximum of two typed pages. May be attached as a separate document.
MCNP Lifetime Achievement Award
Letter of Recommendation *
has been nominated for the Massachusetts Coalition of Nurse Practitioners Lifetime Achievement Award and your name has been given as a supporter of this nomination. Please describe the nominee’s significant lifetime contributions to nurse practitioner practice, education, research or policy on a state (Massachusetts), national or international level.
Signature: Phone:
Print Name: Title:
Position: Date:
[Type a quote from the document or the summary of an interesting point. You can position the text box anywhere in the document. Use the Drawing Tools tab to change the formatting of the pull quote text box.]
Are you a member of MCNP? Yes No
*Maximum of two typed pages. May be attached as a separate document
MCNP Lifetime Achievement Award
Application Checklist
(Incomplete or partial applications will not be considered.)
Completed application submitted by the nominator include:
Nominator/Nominee Information Form
Nominee Resume or Curriculum Vitae (welcome but not required)
SignedNominator’s Letter of Recommendation (from MCNP member)
Two additional signed letters of recommendation*
Completed applications should be mailed to:
Chair, MCNP Awards Committee
C/O Peg Carlson
MCNP
P.O. Box 1153
Littleton, MA01460
Applications must be postmarked by March 31st.
Massachusetts Coalition of Nurse Practitioners
P.O. Box 1153 - Littleton, MA 01460 – 781-575-1565
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