Nurse Administrator of the Year Application
Name of Nominee: _______________________________________________ Credentials:______________________
Address: _________________________ City: ______________St: _____ Zip: ________Phone: __________________
Facility name: _____________________________________________________________________________________
Contact person: ____________________________Phone: ____________________Email: _______________________
1. Attach letters of recommendation, at least two are required please include the contributions that this nominee has made
to the facility and /or the profession of long term care and why this nominee is so special. (One letter must be from a
resident or the residentsʼ family member/friend/care giver and one letter must be from a supervisor, peer or fellow DON.
2. List innovative practices, facility changes or other novel ways of enhancing long term care that this nurse has designed,
coordinated or assisted in implementing.
3. List activities in which the applicant promoted growth or recruitment in long term care nursing
4. Letter indicating why you believe long term care is the nominee’s specialty niche.
Attributes expected to be reflected in winning applicants include:
1. DON with above 5 years of experience in long term care
2. Active Member of NADONA
3. Leadership skills demonstrated through practice, innovative changes or other relationship building activities that
advance the role of long term care
4. Licensed as a Registered Nurse in the state of Michigan, in good standing
5. Actively mentors nurses at the beginning stages of nursing or entering long term care from other fields
7. Assists colleagues in becoming leaders in their facility/community through peer support, networking and
8. Recognized in their community as a leader in geriatric nursing
Please complete the above application by September 1st and e mail to: Julie Pudvay at firstname.lastname@example.org