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ICC 2022 Award Nominations
Fill out the submission form below to nominate someone for an ICC award! Please send any supporting images or documentation to
Mary@indianacancer.org
. For a full description of each award, please visit
https://indianacancer.org/2022-awards/
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* Indicates required question
Your Name (First, Last)
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Your answer
Your Email
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Your answer
Nominee Name (First, Last, and Credentials)
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Your answer
Nominee Email
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Your answer
Nominee Organization
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Your answer
Nominee Address
Your answer
Nominee Phone Number
Your answer
Which award is this nomination for?
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Outstanding Contributions in Cancer Control Individual Award
Outstanding Contributions in Cancer Control Organization Award
David Caldwell Survivorship Award
Cancer Control Champion Award
ICC Sustained Excellence Award
Indiana Cancer Prevention and Control Policy Champion Award
Is this person/organization a members of the ICC?
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Yes
No
Unsure
Tell us why you are nominating this person for an ICC award.
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Your answer
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