2009 Cherokee Inspired Comfort Award

Nomination form for the 2010 Cherokee Inspired Comfort Award!

Note: Electronic nominations for the 2010 Cherokee Inspired Comfort Award must be submitted no later than June 30, 2010. Participation in this award represents your full and unconditional agreement and acceptance of the Official Rules and Nomination Details. To increase the odds of submitting an award-winning nomination, check out our Nomination Tips.

This form will take you about 30 minutes to complete. All fields of this form preceded by an asterisk (*) must be filled out completely to be eligible for consideration.

Important: Once you have started completing the form, you cannot save the information you have entered and return to it at a later time. You should have all the information required below before you fill out this form. For a downloadable paper nomination form, click on the "Communication Tools" at the top of this screen. You will have the opportunity to choose one or both nomination gifts immediately after you submit your nomination. (The gifts consist of a free issue of Scrubs Magazine – the nation's first lifestyle publication for nurses – and a commemorative, golden Cherokee Inspired Comfort Award pin!) The gifts and shipping are free!

Information about the person you want to nominate (the nominee):

*Nominee's first name:
*Nominee's last name:
*Name of nominee's employer:
*Nominee's title at work:
Nominee's telephone number: ( ) -

*Where did the nominee perform the exceptional service, sacrifice or innovation?

: *State: Zip code:

*In what setting did your nominee provide the exceptional service, sacrifice or innovation? (Select one)

*Describe the exceptional service, sacrifice or innovation (in 750 words or less).
To be considered, it needs to have happened during 2009.

*What type of healthcare professional is the nominee? (check all that apply)

  • (aides, patient-care therapists, other clinical personal)

Cherokee Uniforms would be delighted to inform your nominee of your nomination. Please select how you wish this communication to be handled:

  1. I want the person I nominated to receive an email informing them that I nominated them.
  2. I want the person I nominated to receive an email informing them that they were nominated, but I wish to remain anonymous.
  3. I don't want you to inform the person I nominated via email, but I understand that the names and stories behind all nominations may appear on your website.

If you chose choice 1 or 2 please list the nominee's email address here:

Information About You:

*Your first name:
*Your last name:
*Your telephone number: ( ) -
*Your email address:
*Confirm your email address:

If you are a current member of any nurse or professional association, please type the full name of the association:

If you currently attend a school of nursing, please type the full name of the school:

Where do you live?

City: *State: Zip code:

How did you hear about the Cherokee Inspired Comfort Award? You may select more than one.

  • (indicate which one)
  • (indicate which one)
  • (indicate which one)
  • (indicate which school)

Your professional association, school of nursing or employer may be eligible to win a $1,000 grant based on the number of nominations Cherokee Uniforms receives. Whom would you like to receive credit for this nomination? (Choose ONE)

  • Name of School:
    School's Location: City State
  • Name of Association:
  • Name of Employer:
    Employer's Location (City, State):

*Are you related to the person you are nominating?

If so, how are you related?

*How do you know the person you are nominating?

*Do you work with the person you are nominating?

*If you work with your nominee, who is your employer?

*If you work with your nominee, what is your title?

Do you wear uniforms at work?

Name of the Cherokee retailer where you buy your uniforms (if applicable):

Thank you for taking the time to nominate!