PAND Nomination Form Submission
You may nominate yourself (except Outstanding Preceptor Award) or a colleague by completing the below nomination form.  Multiple people from one district may be nominated in the same year. 

The Nominating Committee will either approve or disapprove of the nomination. 

Approval will be granted if the nominee is in good ethical standing with the Academy and have maintained Academy membership. If approved, the Nominating Committee will alert the nominee and will provide the application.

*NOTE: ALL Nominees must be a member of the Academy of Nutrition & Dietetics. All applications will require an Academy Membership Card (copy or screen shot are acceptable). Applications submitted without Academy Membership with the Pennsylvania affiliate will not be eligible for scoring. 

Email *
Who are you nominating? Please indicate their full name below:
What award are you nominating them for: *
What District is the nominee in? *
Email of nominee *
Phone Number of nominee
A copy of your responses will be emailed to .
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms