Award Nomination Form – Attending Awards

For which award are you nominating this Attending?(Required)

Educator of the Year

Mentorship Award

Nominee Name(Required)

Nominee Email(Required)

Nominee Phone Number(Required)

Nominee Position/Program(Required)

Nominator Name(Required)

Nominator Email(Required)

Nominator Phone Number(Required)

Nominator Program/PGY(Required)

If your nominee should win, would you be willing to introduce them at the Awards Gala?(Required)

Yes

Please detail why your nominee should be selected for this award (or attach a letter below)

Please upload any supporting documents here (may include CV and/or letters of support- recommended but not required.)

Max. file size: 20 MB.

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