Impact Award

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60th Annual Convention

Nursing: Honoring the Past and


Shaping the Future
64rd Annual Convention Thursday and Friday, March 3-4th, 2016
Ballys 1900 Pacific Ave Atlantic City NJ 08401

IMPACT Award
Due by January 20, 2016
New Jersey Nursing Students, Inc. (NJNS) members have the opportunity to recognize an
individual who has had an impact on their nursing education and/or career choice. This individual may be
a dean, director, faculty member, mentor or relative who demonstrates support to nursing students.
Purpose:
NJNS has created this award to honor individuals who demonstrate educating and/or supporting a
students professional development.
Awards:
Three awards will be presented based on the essays submitted. Decisions of the committee will be
final. The award will be given at our annual Deans/Directors luncheon on March 3, 2016. The recipient
must be present at the luncheon.
Criteria:
The nominee must have made a substantial impact on, and supported, the student during nursing
school.
An essay describing the activities involved with the student must be submitted by
January 20, 2016.
Application Process:
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The candidate must be nominated by a New Jersey nursing student. The student must be a
member of the National Student Nurses Association (NSNA).
NJNS must receive a completed application by the official deadline.
(NO LATE APPLICATIONS WILL BE CONSIDERED).
Applications will be reviewed by the Awards Committee for eligibility.
The student may nominate only one individual.
Lunch will be provided for the recipient only.
Students should inform nominees of their nomination to ensure their presence at the
Deans/Directors luncheon.
Recipients will be notified by February 1, 2016.

Please email the completed applications to: Regina Adams, BSN, RN at staff@njnsinc.org

IMPACT Award Nomination Form


Deadline: Tuesday, January 20, 2016
Award (check one): _ Dean/Director _Faculty Member _Mentor _Other
Nominee: (print name clearly as you want it to appear on award) ***
Name and credentials (if applicable): ____________________________________
Email address: ______________________________________________________
If other, indicate relationship _________________________
Please attach a typed, double spaced essay (maximum of 500 words) describing the impact that
the nominee has had on your career choice. Include the reasons why you believe that the
nominee meets the criteria for this award.
Student Information:
Name: __________________________________________________________________
School: _________________________________ City: ___________________________
Phone: _________________________________ Email: __________________________
NSNA Membership Number: _______________________________________________
Students Signature: _________________________________________ Date: ________
*** NJNS is not responsible for incorrect names or credentials printed on awards.
If you have any additional questions, please contact Regina Adams, BSN, RN via email at
staff@njnsinc.org, or by phone (609)889-5335 ext. 22

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