2018 APIC Heroes of Infection Prevention

2018 APIC Heroes of Infection Prevention Award Application

This award recognizes APIC members and groups who have work tirelessly to reduce infection, raise awareness, and improve the health and well-being of patients, healthcare workers and the public. APIC aims recognize the great work of six Infection Preventionists (IPs).

The recipients will receive complimentary registration for the 2018 Annual Conference along with a travel stipend to attend the conference in Portland, OR. Recipients and their award winning submission will be featured in APIC’s Prevention Strategists magazine.

* Please Note: Applications must be completed no later than Wednesday, November 15, 2017.*

Application

Q.1

Candidate's Name *

First Name

Last Name

Q.2

Candidate’s Title *

Q.3

Candidate’s institution or place of employment *

Q.4

Candidate’s email address *

Email

Q.5

Candidate’s address *

City

State

Country

Q.6

Current APIC member? *

Yes
No

Q.7

Nominator’s name

Title

First Name

Last Name

Q.8

Nominator’s email address *

Email

Q.9

Area of significant impact *

(please select the most appropriate category):

Process and systems improvement
Program Development
Advocacy and Influence
Education
Patient Safety
Cost savings

Q.10

PRACTICE SETTING (please select most appropriate): *

Acute care
Other, specify
Long term care
Other:

Q.11

Practice Setting *

input appropriate type of facility

Q.12

Number of years working in infection prevention and control: *

Q.13

Upload nomination letter *

Q.14

Upload first letter of reference *

Q.15

Please enter your question here.