CPCNA Awards Nomination Form

To nominate a nurse for either the CPCNA Leadership Award or the CPCNA Lifetime Achievement Award:

  • Seek the nominee’s permission to nominate him or her (Self-nominations are ineligible).

    • The nominee must give permission for the CPCNA to use his or her photo and the reference letters for publicity purposes.

    • The nominee must sign the nomination form (or nominator checks box confirming consent obtained in online form).

  • Procure two letters of support.

    • Letters can be from a fellow nurse,  a member of the CPCNA, another profession or a member of the public. 

    • Each letter should not exceed 500 words.  

    • Please provide specific examples of how the nominee has made significant contributions to palliative care nursing and the CPCNA.

  • Complete the online nomination form.

  • Click 'Submit"

  • Email the following documents to cpcnainfo@gmail.com:

    • One copy of the nominee’s current CV (maximum 2 pages).

    • Two Letters of Support

    • An electronic photo of the nominee which may be used for publicity purposes.

For 2021-- the application and supporting documents must be received by July 30th.

CPCNA Awards Nomination Form 
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A. Nominee Information

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B. Nominator Information

Second Nominator Information (if applicable)

C. Email supporting documents

Thanks for submitting!