CANNT Awards Application Form

IMPORTANT:

Members may apply for more than one bursary/ award per year but will only be able to be the recipient of one award per year. Please submit a separate form for each application. All awards are subject to funding and applicants will be contacted prior to the Annual Conference regarding the outcome of their application.

Terms & Conditions:

The names (and possibly portions of the application) of the selected winners will be published in the CANNT Journal. The nomination forms and content become the property of the CANNT Association and will only be used to promote professional nephrology excellence to its membership.

Who is submitting this application:*

I am the applicant
I am nominating someone else (Excellence in Practice Awards)

Name of Nominator (if not the applicant):*

Email of Nominator (if not the applicant):*

Applicant/ Nominee Information

Name of Applicant/ Nominee:*

Are you a CANNT member in good standing?*

Yes
No

Email:*

Phone:*

Credentials/ Professional Designations:*

City/Province:*

Years as a CANNT member:*

Employer/ Hospital/ Institute:*

Position Held:*

I am applying/ nominating for:*

Frances Boutilier, Franca Tantalo or CANNT Technical Bursary
Excellence in Practice Awards Program
Sponsored Awards

Educational Bursaries

Educational bursaries are awarded to members pursuing further education in nursing or technology. Bursaries are up to $2000.00 and subject to funding.

Please select the bursary you are applying for:*

Technologist
Frances Boutilier (Baccalaureate level)
Franca Tantalo (Masters level)

Please provide a brief description (400 words or less) containing the following information but not limited to:*

- Involvement in CANNT - Clinical Experience - Describe course of study - Demographic information of teaching institution including name of program - Expected date of completion - Explain how this course will be used to enhance nephrology practice - Certified in Nephrology (year) - List any verbal presentations/posters/publications - Involvement in leadership projects

Please use this checklist to ensure you upload all relevant materials with your application. If you do not check all the boxes, your entry will be invalid.*

Proof of acceptance and/or success of course, program
Proof of payment
Resume
Transcripts from educational institution
2 Letters of Reference
Digital photo (winners to be published in the Journal and on the Website)
Short Biography (winners to be published in the Journal and on the Website)

Please upload the requested documents in the list above.*

Drop files here or

Excellence in Practice Awards

CANNT recognizes and celebrates excellence of members through the annual Excellence in Practice Awards Program. The recipients receive a certificate of recognition and are recognized at the annual conference, in the CANNT Journal and on the CANNT website. Please note: Recipients must be nominated by a CANNT member and may not nominate themselves.

Nomination for the Award of Excellence in:*

Please provide a brief description (400 words or less) about the Nominee and why they deserve to be the recipient of the award including but not limited to:*

- Practice (years in nephrology, preceptorship, technical teacher, charge nurse, education) - Continuing education activities - Certified in Nephrology (year certified) - Involvement in CANNT - Participation in other professional associations - Presentations or publications - Involvement in leadership projects

Please upload a digital photo of the nominee. Selected recipients will be recognized in the CANNT Journal and on the CANNT website.*

Please upload a short biography of the nominee (250 words or less). Selected recipients will be recognized in the CANNT Journal and on the CANNT website.*

Complete and Submit

Please answer for all applications (check all that apply):*

I have won this award previously
I have not won this award previously
I have won this award for this PROJECT before
I have received funding for this PROJECT from other sources

I agree to the following terms and conditions:*

The names (and possibly portions of the application) of the selected winners will be published in the CANNT Journal and on the CANNT website. The nomination forms and content become the property of the CANNT Association and will only be used to promote professional nephrology excellence to its membership.