NAPNAP Loretta C. Ford Distinguished Nurse Practitioner Award and Henry K. Silver Advocate Award Nomination Form

Application deadline extended to Nov. 30, 2024

Note: We encourage you to use the Save & Return option to create an account to access your nomination form as often as necessary before the deadline. On your first visit, click New User at the bottom of the screen and follow the prompts. This form is not linked to your napnap.org user/password so you can choose whatever you like to create your account. On subsequent visits, you can use the Return User feature to enter the email and password you originally created.

Each time you visit, complete as much of the form as you wish and click on the Save Progress button at the bottom of your screen. When you are ready to submit your form for review, click the Submit button.

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Nominee's Name *

Title:

State: *

E-mail Address: *

Phone: *

Educational Program:

Highest Degree Earned:

Year graduated:

Educational Program:

Degree earned:

Year graduated:

Educational Program:

Degree earned:

Year graduated:

Current Employment:

Certification (APRN if applicable):

NAPNAP Chapter (if applicable):

Nomination Submitted by (Nominator Name): *

E-mail Address: *

Phone: *

For which award would you like this individual to be considered? *

Please upload nominee's current Curriculum Vitae (in PDF format):

Loretta C. Ford Distinguished Nurse Practitioner Award

Loretta C. Ford Distinguished Nurse Practitioner Award: Award to recognize member for outstanding contributions to expansion or improvement of pediatric health care, and/or advancement of the profession of pediatric-focused APRNs at the state, national, or international level; awarded annually. The nominee must be a current NAPNAP member.

Qualifications:

Service as NAPNAP, NAPNAP Partners, or NAPNAP Foundation national officer, committee chair, or taskforce member
Service on influential regional, state, national or international boards or committees that improve pediatric health, advance health equity and/or advance the profession of pediatric-focused APRNs.
Activities related to state or state or national policy initiatives
Significantly contributes to the promotion and advancement of curricular development or education delivery or clinical practice for pediatric APRNs at the national level.
Presentations to national and international organizations based on recognized expertise and scholarship in the field of pediatric health.
Activities related to improving pediatric health care delivery for children and families within a state, nationally, or globally.
Original publications that have positively impacted the delivery and practice of pediatric health care services.
Contributions have significantly advanced child health outcomes and promoted health equity.
Overall contributions have been significant in expanding or improving pediatric health care, and/or advancement of the profession of pediatric-focused APRNs at the state, national, or international level.

Henry K. Silver Advocate Award

Henry K. Silver Advocate Award: Award to recognize an advocate for outstanding contributions to expansion or improvement of pediatric health care and/or the advancement of the profession of pediatric-focused APRNs at the state, national, or international level; awarded annually. Persons in this category may include, but are not limited to, physicians, administrative executives, health systems leaders, thought leaders or legislators. This award is intended for individuals outside of the NAPNAP membership.

Qualifications:

Service on state, national or international health nonprofit organizations, committees, panels, work groups, or task forces that address pediatric health care issues or state, national, or global health care policies.
State, national, or international service advancing health equity.
Awards or recognition from national or international organizations.
Presentations at national and international meetings based on recognized expertise and scholarship in pediatric health.
Original publications that have changed the delivery and practice of pediatric health care services.
Advocacy to significantly advance the pediatric-focused APRN role at a health-systems, state, or federal level.
Significant advocacy in national print or digital media to advance the pediatric-focused APRN role.
Innovative and large-scale adoption of pediatric-focused APRN-led models of care.
Overall contributions have been significant in furthering the advancement of the pediatric-focused APRN role and/or promoting child health outcomes and health equity.

Submission/Upload for Loretta Ford & Henry K. Silver Awards

Please upload a typed narrative description (500 words or less, in PDF format) of the reasons this nominee should receive the award according to the above-listed criteria for the Loretta Ford or Henry K. Silver award. *

Please upload a minimum of two (2) and a maximum of four (4) separate letters of reference (in PDF format), 1-3 pages in length in support of your nomination. Letters should address how the nominee fits the above-listed award criteria.

Letter of reference #1: *

Letter of reference #2: *

Letter of reference #3:

Letter of reference #4: