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Application Process: Please Read Carefully 

  • Submit contact information for the nominee, nominator and CNO. 
  • Provide information about the nominee's education, certifications, community involvement, honors/awards, professional memberships, etc.
  • Answer the required questions about the nominee's excellence in nursing.
  • Obtain signatures from the following people: nominator (yourself); the nominee/candidate; and the CNO, Director or CEO. Click here to download the signature form. You will then upload the completed signature form, where indicated, toward the bottom of this submission form.

  The application, including all required materials, must be complete at the time of submission to be considered.

Selection Criteria 

  • Exhibits healthcare improvements and contributions via leadership, practice and clinical scholarship
  • Demonstrates noteworthy involvement or influence in healthcare policy and advocacy
  • Contributes to interprofessional collaboration and improves patient and/or population health
  • Significantly contributes to the advancement of nursing practice

 Nominees must live and work in Pennsylvania to be considered.  

We use Submittable to accept and review our submissions.