American Society for Pain Management Nurses

Humanitarian Award

Please complete the application below, including uploading additional required attachments.

The ASPMN Humanitarian Award, established in 2010 by the ASPMN Board of Directors, is presented to an individual in recognition of their outstanding involvement and dedication to the community through their voluntary service.

First Name *

Last Name *

Email *

Name of Nominee: *

Nominee Academic/Professional Credentials: *

Nominee Job Title: *

Nominee Current Employer: *

Nominee Phone Number: *

Nominee Email Address: *

Is the Nominee a Current Member of ASPMN? *

Yes

Nominee's ASPMN Involvement (List Board or Committee Involvement): *

If not addressed in the letter of recommendation, please describe the nominee's commitment to the betterment of the world community through volunteer service. Please include a description of the voluntary humanitarian activity, the date(s) and the approximate number of hours, specifying if the hours are per week, per month, or for a one-time event. Please also include an explanation of how the project influenced the lives of those served. *

Letter of Recommendation (Should not exceed two pages): *

Attach a letter of verification from the organization that describes the project and the compassion and dedication that the nominee showed to the project. *

Attach a statement from the nominee describing how the service they provided impacted their career. *

Nominee's Current CV: *

Nominated By: *

Nominator's Phone Number: *

Nominator's Email Address: *