Palliative Care New South Wales

Online Nomination Form : Nominations close 30th April 2010

Please download and refer to the Awards Criteria document,

We suggest preparing your submission locally on your computer,
and then copy / pasting into the form below.

Award Category
1. Leadership in Palliative Care 2. Outstanding Contribution to Specialist Palliative Care (The Quiet Achiever Award) 3. Innovation in Palliative Care Practice 4. Volunteers Supporting Palliative Care 5. Excellence in provision of Primary (non-Specialist) Palliative Care within a Non-Specialist Care setting 6. Excellence in provision of Palliative Care within a RACF 7. Significance in Palliative Care Research (sponsored by Sacred Heart)
About the Nominator
Nominee's Title :
Nominee's Name :
Nominees's Address :
Nominees's Phone Number :
Nominees's Email :
Nominees's Employer :
Employer's Address :
Nominee's Role :
Does the nominee agree to being nominated?
About the Nominator
Nominator's Name :
Nominator's Address :
Nominator's Phone Number :
Nominator's Email :
Nominator's relationship to Nominee :
PCNSW Membership Number :
About the Nomination
Why do you think this nominee should receive the award? You MUST address the Award Criteria specified in the Criteria and Process document. Complete a statement of no more than 500 words.

Platinum Sponsor : Statewide Centre for Improvement of Palliative Care

Gold Sponsor : Calvary Health Care & Hammond Care

Bronze Sponsor : Sacred Heart Palliative Care Service

Palliative Care New South Wales Awards 2010