Wilma Crockett Memorial Award Nomination Form

BC Kidney Days 2019
October 3-4
Wilma Crockett Memorial Award Reception

Granted yearly to a member of the BC kidney care community, the Wilma Crockett Memorial Award recognizes an outstanding lifetime contribution to the goal of excellence in the care of people with chronic kidney disease. Recipients can include individuals who work directly with patients, as well as program and technical support staff.

(Required fields marked by *)
1. Nominated by:*
Current Address:
 Email Address:*
Phone:
Work: Home:
Fax:
2. Name of nominee:*
Profession: Email address:
Current address:
 Phone:
Work: Home:
Fax:
Position(s) held:

Please fill out the questions below.

Nominees will be evaluated based on the following criteria. Please fill out each question with as much information as you can.

1. History

a. Does the person have a consistent history of deep and continued commitment to nephrology / transplant?


2. Going beyond

a. Has the candidate demonstrated going beyond the job description?

b. Have they contributed beyond their program? Please outline provincial work done.

c. Curious and questioning: in the quest for new knowledge


3. Caring for their patients

a. Has the candidate demonstrated a deep level of caring for their patients? Give an example if you can.

b. Has implemented creative solutions that have improved patient care and quality of life.


4. Caring for their team

a. Has the candidate demonstrated a deep level of caring for their colleagues and team members?

b. Engages and inspires other renal professionals. Give an example if you can.

c. A team player; values all renal professionals.
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