Nomination Form for TGWH Foundation Awards

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Please DO NOT submit more than once, If you need to make changes to your original submission, please send your request to practicebasededucation@uhn.ca

Nominees should exemplify and promote the following:

A supportive learning environment that promotes feelings of safety to ask questions, takes initiative, and address conflict thereby enabling professional development.
Opportunities for continuous improvement in clinical practice through the design and implementation of initiatives that enhance the knowledge and skills of nurses along the learning continuum of novice to expert.
An environment that facilitates lifelong learning.
An innovative way of teaching/coaching that meets "learner" needs.
Positive leadership with staff and students.

Nominee Information

Name of Nominee *

Unit/Department *

Position *

Nominee's Email *

Nominator Information

Name of Nominator *

Unit/Department *

Position *

Nominator's Email *

Phone *

Nomination Information

Nominating for the following (choose one) *

How long have you known the nominee? *

0-1 year

1-2 years

2-3 years

> 3 years

Please provide examples illustrating how the nominee demonstrates the following

Excellence in patient-focused care *

Leadership in improving practice *

Collaboration with colleagues and members of the multidisciplinary team to achieve quality patient/family outcomes *

Consistent commitment to professional development *

Additional Comments

Please add any additional comments that you would like to provide on the nominee *