40 Over 40 Nominations
The Future of Nursing West Virginia seeks nominations for our inaugural
40 Over 40 Awards recognizing WV nurses who have dedicated over
40 years service and leadership in the profession of nursing.
To recognize the outstanding dedication to practice and leadership of the profession of nursing in West Virginia and engage exemplary nurses as mentors
to the next generation in the professional leadership.
Attendance at the September 29, 2018 Gala in Charleston, WV
Engage in at least one FONWV initiative (ex. serve on a board, as a mentor, team member, Ambassador, gala promotion...) for at least 2 years
Begin by nominating yourself or someone else on this form
Nominator or Reference completes the three Qualification Questions
Nominator Questions (pdf)
Nominee digital photo in jpg format
Nominations are confidential: Names/identifiers are deleted for evaluators
Nominations must be complete to be considered
Nomination Deadline: Thursday, May 31, 2018, 11:59 PM
Currently licensed RN in West Virginia
Dedicated over 40 years to the practice & leadership in nursing by August 1, 2018
Significantly or uniquely contributes to leadership through clinical practice, education, teaching, administrative governance and/or healthcare innovation
Demonstrates leadership/contributions in: community affairs, nursing professional organizations, and/or assisting others' growth and development in these areas,
Positively promotes and advances the nursing profession in the community (local/regional/national/global) through volunteerism, outreach or legislative/policy development work,
Nominees willing to engage in FONWV initiatives or mentoring.
A team of reviewers composed of experienced nurses and two consumers will review the blind nomination forms.
Qualification Questions (completed by Nominator/Reference)
Answer all questions DO NOT USE nominee name and identifiers.
Refer to the person as The Nominee, She/He... This facilitates blind review.
(Narrative limited to 250 words per question; 1 inch margins; 12 pt font size)
1) How has your nominee shown concern for humanity?
2) What do you consider your nominee's most significant contribution
to the profession?
(Describe how the Nominee positively promotes and advances the profession of
nursing in the community (local/global) through volunteerism, legislative and policy
development or other innovations or advancements in nursing science or education.)
3) How has your nominee served as a mentor or role model for others?
(Demonstrates leadership in community affairs, nursing professional organizations,
board service and/or has assisted others to grown and develop in this area.)
Awardees will be selected by an objective panel of judges appointed by the FONWV 40 Over 40 Team according to the specified criteria, without names and identifiers.
Awardees will be notified by July 15 so plans can be made for the awardee to attend the Awards Gala on September 29 evening reception courtesy of FONWV.