Dedication to Excellence
Nurses Award
Award Criteria
$500
Information
The Inland Empire
Healthcare
Education
Consortium
(IEHEC) would like
to award nurses for
their time and
dedication to
nursing students
and the nursing
profession.
The IEHEC awards
are for nurses who
are employed in a
facility that is an
active member of
the Consortium.
The IEHEC is looking
to award nurses who:
Nomination Deadline:
February 8, 2017
Nomination Process:

Complete a Nomination Form and
have it signed off by your facility or
school of nursing

Complete a Dedication to Excellence
Award Criteria Form
 Demonstrate
excellence and
professional
modeling
 Ongoing
willingness to
mentor students
 Demonstrate
outstanding
nursing
mentorship and
student
teaching
 Actively
participate in
professional
organization
For More Information go to www.iehec.org
Application and required documents can be submitted to:
Inland Empire Healthcare Education Consortium, Attn: Awards Committee PO Box 12223, San
Bernardino, CA 92403
Inland Empire Healthcare Education Consortium
Dedication to Excellence Award
The Inland Empire Healthcare Education Consortium awards are for nurses who are employed in a facility
that is an active member of the Inland Empire Healthcare Education Consortium. The goal of the Inland
Empire Healthcare Education Consortium award is to reward nurses who have exemplified outstanding
professional modeling and mentoring to nursing students.
Eligibility criteria
Please read the award requirements before completing this application packet.




Be a licensed nurse employed at a facility that is an active member (dues paid) of the Inland Empire
Healthcare Education Consortium
Willing to work with nursing students to meet clinical course objectives and implement evidenced
based nursing practice.
Demonstrates creativity in approach to student teaching.
Demonstrates outstanding nursing mentorship by regular and ongoing willingness to teach/precept
students throughout the year.
o is current in nursing practice
o works with student to achieve realistic goals
o monitors progress and provides ongoing constructive feedback
o understands how to resolve conflicts with students
o active member in a professional nursing organization
The following items must be included in the nomination process:

Nomination Form completed by the nominator and signed off by the facility or school of nursing

Dedication to Excellence Award Criteria Form completed by the individual (nominator) referring
the candidate
Must meet deadline for submission, February 8, 2017

Awards will be evaluated by the Inland Empire Healthcare Education Consortium Awards Committee.
Application and required documents can be submitted to:
Inland Empire Healthcare Education Consortium, Attn: Awards Committee PO Box 12223, San
Bernardino, CA 92403
Inland Empire Healthcare Education Consortium Dedication to Excellence Award
Criteria Form
**Comments are required and specific examples of how the behavior/concept was demonstrated needed.
Name of Person Being Nominated:
Agency:
Please describe the nominee’s official role with students (staff nurse, preceptor, etc.) and discuss the frequency.
Please rate and comment on the following nurse mentor criteria:
Works with students to meet clinical course objectives and implement
evidence-based nursing
Comments:
Demonstrates consistent, ongoing willingness to teach/precept
students throughout the year
Comments:
Is currently working in nursing practice
Comments:
Works with student to achieve realistic goals
Comments:
Consistently monitors student progress and provides ongoing
constructive feedback
Comments:
Understands how to resolve conflicts with students
Comments:
Demonstrates creativity in approach to student teaching
Comments:
Continued on next page
Strongly
Agree
Agree
Slightly
Agree
Disagree
Is an active member in a professional nursing organization
Comments:
What makes your nominee stand out from the rest of the nominations that will be received? (Describe
characteristics, examples of how this nominee exemplifies excellence, such as specific teaching examples, etc.)
Additional Comments:
Name and Position of Person Completing this Form:
Agency/Facility:
Inland Empire Healthcare Education Consortium
Dedication to Excellence Award Nomination Form
Nurses Data:
Name:
Place of Employment____________________________________________________________________
Address with Zip Code
Home
Work
Contact Number: ______________________________________________________________________
Email (required):
_____________________________________________
Professional Organization Membership(s)___________________________________________________
Facility-based committee(s):______________________________________________________________
Referral:
Name of Referring Facility or School_______________________________________________________
Referred by___________________________________________________________________________
Referral’s contact number and email_______________________________________________________
The following items must be included in the nomination process:

Nomination Form completed by the nominator and signed off by the facility or school of nursing

Dedication to Excellence Award Criteria Form completed by the individual (nominator) referring the
candidate

Must meet deadline for submission
Nominator
Print Name/Signature
Title
_
Date
Education Department Signature (If nomination from a hospital) or Faculty Signature (if nomination from a school) and
additional supporting comments:
_____________________________________________________
Print Name/Signature
Title
______________
Date