Nomination Form


		Thank you for taking the time to recognize a cancer nurse. Please complete the following information so that we can send this nurse his or her recognition card. Please tell us how you heard about the Honor Someone Special program: * Through an ONS publication (newsletter, journal article) Surfing the ONS website From my local ONS Chapter or Special Interest Group (SIG) Via social media (Facebook, Twitter, Crowdvine, etc.) Advertisement (USA Today, other local and/or national media) From a friend, colleague, family member Display (poster, response card, local event display) Other If other, please specify: Special Nurse Name * Place of employment * City, state, zip * Work phone Tell Us a Little About You, the Nominator Your Name * Address * E-mail * Phone * Tell us how this nurse* has provided you with excellent cancer care or demonstrated excellence in the nursing profession. Please check the top three qualities that best represent this nurse: Top Three Qualities Caring Coaching Collaborative Communicative Compassionate Considerate Decisive Educational Empathetic Hopeful Influential Innovative Inspiring Kind Knowledgeable Mentoring Pleasant Powerful Responsive Scientific Supportive Understanding Other Please tell us, in approximately 100 words, what makes this nurse special. * * Only registered nurses qualify for the Honor Someone Special program. Enter text seen in image* Try a different image * denotes required field

You may also download the nomination form in PDF format to print and fill out. If you choose this option, please complete the form and send it to:

Attn: Membership Team
125 Enterprise Drive
Pittsburgh PA, 15275

Or fax to: 412-859-6163