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 

A. Nominee Information


B. Nominator Information

Second Nominator Information (if applicable)

C. Email supporting documents

Thanks for submitting!