NAHUC AWARD NOMINATION FORM

Per NAHUC Policy 2106, All Nomination Forms are to be sent to the NAHUC  Office on or before April 1.  Nominations should be in narrative form of not more than four pages and must contain  supportive evidence for criteria

Category: Certified Health Unit Coordinator or Outstanding Individual (please circle one)

Certified Health Unit Coordinator Criteria: Nominee must be a member in good standing of NAHUC for at least one year.  Nominee must be a Certified Health Unit Coordinator with current certification status, working in a hospital or health care facility.  Must be a role model for peers and practice personal and professional development through continuing education.  Must actively participate in NAHUC at local or national level.

Outstanding Individual Criteria: Nominee must be a member in good standing with NAHUC for at least one year.  Must promote health unit coordinating through certification, continuing education, or the recertification process.  NAHUC Board Members can only be nominated for the Outstanding Individual category.

 1.    Nominee Name__________________________________________________________

        Address________________________________________________________________

        City _________________________________ State/Prov ______  Zip code/PC ______________

        Phone_____________________________ E-mail ______________________________

 2.         What has he/she done to promote NAHUC and the health unit coordinator profession? 
        (i.e., locally, regionally, and/or nationally)  Submit on separate sheet.

3.        Additional comments. Submit on separate sheet.

4.         Name, address, and phone of person submitting the nomination:

            _____________________________________________________________________

            _____________________________________________________________________

            _____________________________________________________________________

            _____________________________________________________________________

Complete the form above and submit with narrative answers to questions 2 and 3.

Mail or fax to NAHUC prior to April 1.

NAHUC
1947 Madron Road
Rockford, IL  61107-1716
Fax: 815-633-4438