Award Information

Permission to Publish:

Do you give The DAISY Foundation and its partners permission to publish the DAISY Award nomination story and/or the photo submitted with this registration? We request your authorization to use both in various media including our website, speeches/presentations about DAISY, and in collaboration with other organizations and their media that help us support and promote DAISY and the meaningful recognition of nurses.

Definitions of Permission to Publish Options:

"Yes" - You have checked with your DAISY Honoree and have permission to post their name, picture, and/or nomination story online. You agree to the conditions above. A spotlight will be created and they will be featured on our website!

"Register but do not publish"- You have checked with your DAISY Honoree and they want to be in our database, but not posted on our website for privacy or other concerns. Their name, photo, and nomination story will not be collected or shared. Please only use this option for privacy or legal concerns as the information can not be changed or published moving forward.

"No"- You have not checked with your Honoree, or your Honoree denied permission of any kind.

Request Permission to Publish

Please do not register your Honoree(s) without receiving their permission. We do not require documentation, but ask that you confirm with them the above consent. If you have any questions, please contact your Program Team.

Type of Registration

Type of Award

About Your Honoree

Honoree's First Name:

Honoree's Middle Initial, If Known. (This helps us differentiate Honorees with the same name.)

Honoree's Last Name:

Honoree's Title: (example: Staff Nurse, Nurse Manager, Lead, etc.)

Honoree's Credentials:

Unit:

Practice Site:

Please enter the practice site here:

Educator Role:

Was this nurse working on night shift at the time of the nomination?

Yes
No

Award Date:

Month

Year

Does your Honoree serve as a Preceptor in your institution?

Is your Honoree an actively practicing Nurse Practitioner?

About Your Team

Team Name (max 80 characters):

Team Unit If Applicable:

Award Date:

Month

Year

All Team Members (Please include their first and last name, as well as credentials E.G.: Megan Smith, RN):

Location Information

Your organization's name as listed on our roster (please be as specific as possible: E.G. Kaiser Permanente Oakland Medical Center NOT only Kaiser Permanente):

Setting:

City

Country

State

Provinces

State/Province

Nomination Story

PLEASE DO NOT UPLOAD SCANS/PDFs/PICTURES. You must use text only- all other file types will be rejected.

Please note that your story may be edited prior to publication. For example, we will remove names of patients to ensure HIPAA compliance; anything phrased in a negative way; criticism of any healthcare organization, etc.

Nomination Story:

Picture:

For individual Awards, the photo should only feature the Honoree. If your photo contains more than the Honoree, please crop it before attaching here. If needed, we will crop it to protect the privacy of others and to honor the individual for their compassionate care.

Please Upload Your Honoree's Photo Here:

About You:

Your First Name:

Your Last Name:

Your Email (to receive confirmation when Spotlight is live):

If there is an additional person who should receive confirmation when the Spotlight is live, please enter their email below:

Additional email to receive notification:

Acknowledgement

By checking this box and submitting the 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 Policy 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 our Privacy Policy.

I Agree

Contact Information