Massachusetts Association of Public Health Nurses
		Annual Public Health Nurse Award

Nomination for 2016

Nominee’s Name:      

BOH Address of Nominee:      

Nominee’s phone                Nominee’s Email      

Brief Biography/special information regarding candidate:      

Please note any specific contributions to Public Health Nursing this candidate has made:      

Name of individual /peer nominating PHN:      

Date:             Phone:                   E-mail:      

Please complete the form and send to the Awards Committee Chair, Pat Zingariello.  The deadline is March 25th, 2016. 

The form can be mailed to her at 24 Grandview Ave, Wakefield, MA  01880 or emailed to patzing@comcast.net.  If you have any questions, feel free to call Pat @ 781-587-1448.

The Award will be presented at the 2016 Massachusetts Association of Public Health Nurses Conference.