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GHG Scholarship Program

DAISY Award Nomination Form

Nominations received by the 15th of the month will be considered for the following month's DAISY Award.

If you have any questions, please contact: Joan McCann Magnet Program Supervisor 563-421-7674 or

I would like to nominate: from unit/location as a deserving recipient of The DAISY Award. This RN's clinical skill and especially her/his compassionate care exemplify the kind of nurse that our patients, their families, and our staff recognize as extraordinary.
She/he consistently meets all of the following criteria:
  • Demonstrates professionalism in the work place
  • Models empathy and demonstrates a caring attitude in all situations
  • Job performance exemplifies the mission, vision, and values
  • Uses critical thinking skills in the delivery of extraordinary patient care
  • Consistent focus on creating an exceptional patient experience
  • Demonstrates excellent interpersonal skills with peers and coworkers
  • Recognized as outstanding role model in the nursing community
  • Demonstrates exemplary service and a commitment to excellence
Please tell a specific story (limit 500 words) about the nurse you are nominating that clearly demonstrates he/she meets the criteria for the DAISY Award.

Thank you for taking the time to nominate an extraordinary nurse for this award. Please tell us about yourself, so that we may include you in the celebration of this award should the nurse you nominated is chosen.
Your Name: *
Phone Number: *
E-mail Address: *
I am (please check one):
 RN    Patient    Family/Visitor    MD   Staff       Volunteer 
Date of Nomination: