Fy17 Advocate of the Year App

American Association of Nurse Anesthetists Foundation

Advocate of the Year Award

Please feel free to copy and distribute the Advocate of the Year Award Application

American Association of Nurse Anesthetists Foundation 222 S. Prospect Avenue, Park Ridge, Illinois 60068 Phone: 847-655-1170 / Fax: 847-692-6968 [email protected]

Accepted by BOD 2/18/2015 Advocate of the Year

AANA Foundation Advocate of the Year Award: This award is presented to an Advocate of the AANA Foundation for outstanding commitment to the nurse anesthesia profession through supporting the AANA Foundation as well as encouraging others to do the same.

Criteria and Nomination: Individuals or entities wishing to be considered for this award may self-nominate or be nominated by another person through submission of a nomination form that details their contributions to the nurse anesthesia profession. The AANA Board of Trustees will review the nomination forms, and select the recipient based on the degree to which the following criteria have been met:

 Made substantial contributions to support the AANA Foundation in terms of time, talent, and direct financial contribution  Developed an initiative(s) that has generated interest in and support of the AANA Foundation at the national and/or state level

Selection: The Advocate of the Year will be selected in the following manner:

 All nomination materials must be submitted by March 15  The AANA Foundation Board of Trustees will review all the nomination materials and select the recipient based on the degree to which the criteria have been met  The award will be announced to the public at the AANA Annual Congress

Recognition and Benefits: Recognition will be awarded to the Advocate of the Year during the AANA Annual Congress, and the Chair of the AANA Foundation Board will honor the recipient with a speech detailing specific accomplishments. Additional recognition and benefits* include:

 Airfare and two nights of lodging for the Annual Congress  Registration for the Annual Congress  Publicity in various AANA and AANA Foundation publications throughout the following year

There are no additional benefits beyond those expressed in this document.

Deadline: The submission deadline for the AANA Foundation Advocate of the Year Award is March 15. * If an entity is awarded, recognition will go to the entity overall, but expense benefits will be awarded to only one individual representative of that entity. Accepted by BOD 2/18/2015 AANA Foundation Advocate of the Year Award Nomination Form

Your Name: ______Email: ______

Name of Nominee: ______

Nominee’s Credentials/Title::______

Member Only Section Nominee’s AANA #: ______Email:______(if an AANA member)

State Represented: ___ # Years served as an AANA Foundation State/Student Advocate:____

Is the person being nominated CURRENTLY a State/Student Advocate? ____YES ____NO

Please answer the questions below as accurately as possible. Write or type your answers on separate sheets of paper, and return them with this form. Please limit your responses to 500 words or less PER QUESTION, for a maximum of 1,500 words TOTAL.

1) Why does the nominee support the Foundation?

2) Describe ways that the nominee has donated time, talent, and direct financial support to the AANA Foundation.

3) Describe a fundraising or educational program since September 1, 2012, that the nominee has put into motion at the state/national level that has generated interest in/support for the Foundation, or advanced the Foundation’s mission “to promote and fund research and education endeavors.”

4) Submit a current curriculum vitae for the nominee (Not applicable if nominee is not an AANA member).)

Please send this form, along with your answers to the above questions, to the AANA Foundation. All forms received by the deadline will be forwarded to the AANA Foundation Board of Trustees. The Advocate of the Year Award will be announced to the public during the AANA Annual Congress.

Please send your application and all supporting documents in one email with “Advocate of the Year Award Application” in the subject line to: [email protected].

Accepted by BOD 2/18/2015 Deadline ~ March 15

Accepted by BOD 2/18/2015