Dora Roylance Prize Nomination Form

 

The Dora Roylance Prize for Student Health Visitors

For students who have completed the Specialist Community Public Health Nursing (SCPHN) Health Visitor programme.

  • Nominator

  • Nominee student

  • A postal address is required for all recipients of any QICN funds.
  • DD slash MM slash YYYY
  • DD slash MM slash YYYY

  • Criteria

    The following section will help the QICN understand how universities are selecting the most outstanding Health Visiting student of the year.
  • (e.g. highest mark in practice, highest mark overall during the course)

  • Data protection

    Your privacy is important to us, and we will NOT pass your details to any third party. The Queen's Institute of Community Nursing will use the information provided on the application form to process the award only. We will also use the information to communicate with you on issues which we feel may be of interest to you. By providing us with your information, you consent to us using it for the purposes outlined above.
  • DD slash MM slash YYYY
  • This field is for validation purposes and should be left unchanged.
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