Preceptor Form

Education Student New Graduates Preceptor of the Year Preceptor Form

Preceptor of the Year Nomination Form.

COMPLETED BY STUDENT.

Your Name:

Your INMO No.:

Your Place Work/Study:

Mobile No.:

Your Email Address:

PRECEPTOR.

Name of the Preceptor you wish to nominate:

Preceptor Place of Work/Study:

INMO No.:

Mobile No.:

Email Address:

Please write in 100 words or less why you are nominating this nurse/midwife for the Preceptor of the Year Award:

Input symbols

Please tick this box to give INMO permission to use the contact details you have given above to update you with important INMO information. This information will NOT be given to any other third party at any time.

Irish Nurses & Midwives Organisation (Cumann Altrai agus Ban Cabhrach na hEireann). The Whitworth Building, North Brunswick Street, Dublin 7. T:+353 1 664 0600 E:inmo@inmo.ie