PRECEPTOR AWARD NOMINATION

Lakeridge Health is strongly committed to providing an exceptional learning environment for the development of students within the health professions. This achievement is only made possible through the effort of our staff to share their valuable skills and knowledge. To celebrate the contributions our preceptors make throughout Lakeridge Health, we actively seek preceptor award nominations in following four categories:

Lakeridge Health Nursing Preceptor Award
Lakeridge Health Non-Clinical Preceptor Award
Lakeridge Health Clinical Preceptor Award
Lakeridge Health Medical Trainee Preceptor Award

1. Nominator's/student's name:

2. Educational institution:

3. Email:

4. Start date of placement: This question requires a valid date format of MM/DD/YYYY.

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5. End date of placement: This question requires a valid date format of MM/DD/YYYY.

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6. Location of placement:

7. Please choose the award you are nominating your preceptor for:

8. Name of preceptor/nominee:

9. Preceptor email:

10. Lakeridge Health Program:

11. Preceptor discipline:

12. Briefly describe how long have you known the Nominee/Preceptor:

13. Tell us why you are nominating this preceptor (100 words or less):

14. Please confirm the following: