Awards Application

Please complete the following application in order to nominate yourself or a colleague for one of ANAC's prestigious awards. Please be sure that you have read through the Awards Description and Eligibility Documents before proceeding.

This form will not automatically save what you have entered, and if you close out of the form before submitting, you will lose all contents.  Please be prepared to submit the entire form in one session.  In order to submit your application, please complete all required fields and scroll to the very bottom of the form and click "Submit."  Your application will not be filed until you click the "Submit" button. 

Deadline:  March 31, 2026.

NOMINEE'S INFORMATION

Award Category (Please select ONE): *
Nominee's Name: *
ANAC Member Number:
Email Address: *
Address:
City: *
State
Zip Code:
Country: *
Employer Name: *
Position/Title: *
Area of Nursing Practice (Select all applicable areas): *
If Other, please describe:
Is the nominee a current member of ANAC? *

Clear Selection
Please confirm that the nominee consents to being nominated for this distinguished award: *

Clear Selection

NOMINATOR'S INFORMATION

Multiple Nominators for the Same Individual

If more than one person or group plans to nominate the same individual for this award, we strongly encourage you to collaborate and submit a single, unified nomination form whenever possible. A joint submission allows the selection committee to review one comprehensive and cohesive application rather than multiple separate nominations for the same nominee.

If submitting as a group:

  • Please list all nominators within the designated section (e.g., Nominator 1, Nominator 2, etc.).
  • You may include multiple perspectives and statements within the same form.
  • Clearly label each contribution if providing individual comments.

While multiple nominations will be accepted, a coordinated submission is preferred and appreciated.

Nominator 1 Name: *
Nominator 1 Email: *
Nominator 2 Name:
Nominator 2 Email:
Nominator 3 Name:
Nominator 3 Email:
Address:
City: *
State
Zip Code:
Country *
Relationship to Nominee (Select all that apply): *
If Other, please explain:
Nominator 1 Current Position/Title: *
Nominator 2 Current Position/Title:
Nominator 3 Current Position/Title:

Instructions: Please review all sections of the award descriptions for the appropriate award category.  They will provide guidance on completing the questions for each award category.  All sections have a 2,000 character limit.  The system will decline your submission if any section exceeds 2,000 characters.  We recommend you save your responses in a Word document so that you have a backup of your work.

Introductory Statement by Nominator: *
Describe the Nominee's commitment and contribution to the field of HIV that reflect the award category *
Position Role/Description *
Innovation, Creativity and Collaboration *
Compassionate Caregiving *
Additional Supporting Information (Not required):

The following questions apply only for the Research/Impact Award

If you are nominating someone for the Research/Impact Award, please upload their CV here.
If you are nominating someone for the Research/Impact Award, please upload only one letter of support here.



Your form submission WILL be encrypted using SSL to ensure your privacy.

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