Academic Excellence Award Nominator’s Checklist
Note: Please use this form as a guide for information gathering and for organizing
your submission.
Submissions are NOT accepted by scan or fax. All
submissions must be entered online into Jot Form.
Field
EXCELLENCE IN ACADEMIA AWARD: Advancing Academic Excellence in
of Nursing Simulation & Clinical Laboratories
“This
a ward
i s
g iven
t o
a
m ember
w ho
d emonstrates
a
s ustained
r ecord
o f
t eaching
excellence
i n
S imulation
T eaching
a nd
L earning
i n
A cademic
S ettings.
T he
s uccessful
nominee
d emonstrates
f lexibility,
c reativity,
e nthusiasm
f or,
a nd
i nnovation
i n,
t he
delivery
a nd
d issemination
o f
s imulation-‐based
e ducation
w here
e ducational
endeavors
a re
v alidated
b y
e vidence
o f
p ositive
o utcomes
f or
s tudents
a nd/or
f aculty.
Moreover,
t he
n ominee
c onsistently
e mploys
I NACSL
S tandards
o f
B est
P ractice:
Simulation
( 2013)
i n
t eaching
a nd
l earning
a nd
i s
h eld
i n
h igh
r egard
w ith
s tudents
a nd
colleagues.”
Nominee Information:
First and Last Name __________________________________________________
Title and Credentials __________________________________________________
Home Address: ______________________________________________________
City __________________________________ State/Province _________________
Country __________________________Zip/Postal Code _____________________
Email Address _______________________________________________________
Nominator Information (person submitting the award if not self-nominating):
First and Last Name __________________________________________________
Title and Credentials __________________________________________________
Home Address: ______________________________________________________
City __________________________________ State/Province _________________
Country __________________________Zip/Postal Code _____________________
Email Address _______________________________________________________