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Commit to the DAISY Faculty Award

Commit To The DAISY Faculty Award!

Please complete all boxes to tell us how you intend to implement The DAISY Faculty Award program.

Name of your academic institution and school/college of nursing as you would like it listed on our roster (e.g. Florida Atlantic University; Christine E. Lynn College of Nursing)

Approximate number of faculty members

Your school/college's web address (e.g. www.school.edu)

Your DAISY Plan

How many Faculty Awards per year will you present?

Approximately when do intend to present your first Faculty Award? (We know you don't have an exact date, but please choose an approximate date for planning purposes.)

At what event do you think you will present your DAISY Faculty Award (you may change this later).

Funding Your DAISY Faculty Award Program

When you commit to The DAISY Faculty Award by completing this form, we will email an invoice to the person you designate below around the date you request. This will pay for your first year's DAISY gifts and everything you need to get your program underway. Thank you!

To whom should the invoice for your program be sent ($125 per Award)?

Invoice first and last name

Invoice email (e.g. yourname@school.edu)

Invoice phone number (e.g. (555) 555-5555)

When shall we email your invoice?

Who will be your DAISY Faculty Coordinator?

Coordinator first name

Coordinator last name

Coordinator title

Coordinator email (e.g. yourname@school.edu)

Coordinator phone (e.g. (555) 555-5555)

Name of the committee or team that will run your DAISY Faculty Award

To whom should we ship your DAISY Faculty Award gifts and materials?

Ship to School/College name

Ship to first and last name

Ship to title

Shipping email (e.g. yourname@school.edu)

Shipping phone (e.g. (555) 555-5555)

Shipping mailstop/office building/room #, etc.

Shipping street address

Shipping city

Shipping state

Shipping zip code (9 digits, if possible)

Who will sign your Faculty Award Certificate (e.g. Dean?)

Signer first name

Signer last name

Signer credentials

Signer title

Signer email (e.g. yourname@school.edu)

Signer phone (e.g. (555) 555-5555)

Do you want a Faculty Award Banner to celebrate your Honorees? This 7 foot long vinyl sign is available at $100.

YesNo

In case we need to contact you with a question, may we have the email address of the person who completed this form, please?

Note: is there anything else you want us to know?

Thank you so much for your partnering with us to recognize the important contribution your nursing faculty make to their students and patient care. We will be in touch with you right away.

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National Sponsors

Supportive Associations

The American Assembly
of Men in Nursing

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