HealthImpact DAISY Nurse Leader in Policy Award

Nomination Form

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Licensed nurses who are employed by DAISY Partner organizations or schools of nursing including students and faculty in the United States.

Nominee may or may not have policy development or oversight as a part of their job description.

Nominee’s policy change must have taken place in the last two years prior to the first day of the application opening for this award.

Individual nurses or nurse-led teams are eligible to apply.

Please complete the nomination form addressing all elements in the Nomination Criteria.

About You

About The Nominee

About The Team

Where Does The Nominee Work?

Your Nomination
Please provide detailed information in each section of the nomination below. 200 Words per answer.

For questions about this Award please contact Sharon Goldfarb at

If you have technical issues with this form, please contact Christina Johnson at