JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
2020 ACU Award Nominations
The deadline to submit a nomination is Friday, March 27, 2020
For questions, please contact Sabrina Edgington at
sedgington@clinicians.org
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
For which award category are you nominating a candidate?
*
Choose
Clinician of the Year
Organizational Excellence
Health Professional in Training
Congressional Champion
Marc Wetherhorn Advocate of the Year Award
Up & Coming Leader Award (NHSC 50th Anniversary Award)
Lifetime Service Award (NHSC 50th Anniversary Award)
Name of Nominee
*
Your answer
Nominee email address
*
Your answer
How do you know the candidate?
*
Your answer
Please describe the qualities you feel make this person or organization deserving of recognition this year. Limit 350 words.
*
Your answer
If chosen, will the nominee be able to attend the 2020 Annual Conference or NHSC 50th Anniversary Gala in Washington D.C.?
*
Yes
No
What is your name?
*
Your answer
What is your phone number?
*
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of ACU.
Does this form look suspicious?
Report
Forms