Request a Tribute Please enable JavaScript in your browser to complete this form.IMPORTANT: The requestor MUST be the person the tribute is for OR from the honoree’s family, clergy, hospice agency, funeral director, or funeral planner. Colleagues cannot request tributes, but they can share our information with the family and they can request us if they choose. Type of tribute desired *— Select Choice —Deceased (final tribute)Alive (living tribute)Living tributes are for nurses who are and must be currently enrolled in a palliative care or hospice program. Final tributes honor nurses posthumously (after they are deceased). Requestor name *FirstLastRequestor email *EmailConfirm EmailRequestor phone *Relationship to the nurse honoree *Name of the nurse being honored *Respectfully, the WNHG will honorably offer one tribute (living or final) per nurse per lifetime, but not both. Thank you for your understanding. Highest level of nursing practiced by the honoree *— Select Choice —LPNRNAPRNDNP/PhDExpected date of tribute *Expected time of the tribute *Our tribute lasts approximately 10 minutes. WNHG volunteers arrive approximately 30 minutes prior, leave immediately after, and therefore it is imperative to gather approximate timing in order to schedule volunteer attendance. Location of service (please provide address and please specify if this is a business/facility/church/funeral home/venue hall/private residence). *Attach photos of the honoree or background documents (work history, career specialty, nursing education, graduation dates, resume, etc.) Drag & Drop Files, Choose Files to Upload We appreciate vintage photos of nursing graduation, headshots, with capes/caps if possible. Biography / Background *Please list pertinent information about the nurses education (school(s) of nursing attended and year(s) of graduation), credentials and/or certifications obtained, places and specialties worked, military service, favorite places worked, any special touching career related stories, etc. Link to obituary Please copy and paste link to obituary if one is available. Who will be receiving the ONE honor gift from WNHG (name and relationship to the honoree) *The WNHG provides a single white silk rose (or depending on stock, a ceramic “lamp of knowledge”) to the family/honoree. We will need a name and relationship of the individual who will be the recipient of that single gift.WNHG website and FB posting permissions *— Select Choice —YesNoDoes the requestor allow the WNHG to create and post a tribute note and photo of the honoree on our Facebook business page and business website’s wall of honor?Please note: when requesting any WNHG tribute, you understand that we are a fully volunteer ran organization. Therefore, attendance of WNHG volunteers at any requested tribute is based on volunteer availability and our presence is not necessarily a guarantee of this request for tribute. Requestor is this Type "I agree" if you agree and understand this *Submit