DAISY Student Award Nomination Form

Nominate an extraordinary nursing student for the DAISY award.

1. First name of the nursing student you are nominating:(Required)

2. Last name of the nursing student you are nominating:

3. Please describe a specific situation or story that clearly demonstrates how this nursing student made a meaningful difference to you. (See example story at bottom of nomination form) Note: If using a mobile device to enter this E-Nomination you can easily enter your story by selecting the microphone button on your device and dictating your story instead of typing.(Required)

4. Your name:(Required)

Please tell us about yourself. We may contact you if we need more information about your nomination or if your nursing student has been selected to receive The DAISY Award.

5. Phone:

6. Email:(Required)

7. I am a:

8. By selecting "Yes" and submitting this online form, you agree to The DAISY Foundation and/or its partners collecting and storing the information you submit, including your personal contact information, in accordance with the DAISY Foundation Privacy and applicable law. The DAISY Foundation or the organization where your nurse works may contact you with questions about your submission. To learn more, please read The Daisy Foundation Privacy Policy at https://www.daisyfoundation.org/privacy-policy.(Required)

Yes

Example Story: "Our 88 year old mother was a patient for 2 weeks. Mom was on a roller coaster, we never knew what to expect. Everything was new and frightening to us as we watched her struggle to live. Through it all, Tami was there, working tirelessly, diligently, helping Mom and us understand issues and ramifications. She patiently explained things to us, sometimes more than once, until we got it. Of utmost importance to her was Mom's comfort. Tami was also concerned-expressed repeatedly-about each of us, Mom's family, as we went through our own emotional and exhausting roller coaster rides. We looked forward each day to seeing Tami. She obviously cared deeply for Mom. Tami became like family to us. I wanted to hug her hello and goodbye. Everyday her knowledge and skills were evident. Such as, for one tiny example, the day 02 saturation was dropping, chest tubes were in, Tami analyzed the best position to put mom into with those tubes in order to maximize 02 saturation. It worked. Tami's tireless, devoted, and skilled passion for our mother's well being made a huge impression on us. She stood out as a nurse willing and able to go beyond the normal call of duty."

DAISY Student Award Nomination Form

School of Nursing