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2025 NHNPA Award Nomination
Please complete the form below to nominate an individual for one of NHNPs annual awards.
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Your first name
Your answer
Your last name
Your answer
Your phone number
Your answer
Your email
Your answer
Your employer
Your answer
Your role
Your answer
Which award are you nominating someone for:
NP of the Year
Lifetime of Service
Advocate of the Year
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Nominee's first name
Your answer
Nominee's last name
Your answer
Nominee's credentials
Your answer
Nominee's email
Your answer
Nominee's phone number
Your answer
Nominee's Employer
Your answer
City/Town of Employer
Your answer
Describe how the nominee meets to award criteria and reference relevant evidence.
Your answer
Describe the qualifications and accomplishments of the nominee.
Your answer
Provide two points highlighting the achievements of the nominee.
Your answer
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