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Awards Program Common Application & Nominations Form

Awards Program Common Nominations Form

Contact Information for the Nominee (You may self-nominate or nominate someone else.)

Name(Required)
Address(Required)
Does you identify as underrepresented in medicine (URM)?(Required)
*The APA defines URM using the AAMC's 2004 definition: "Underrepresented in medicine means those racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population," which includes the following racial and ethnic groups: Black or African American, Hispanic/Latino, Native American or Alaskan Native, Native Hawaiian and other Pacific Islander.
Ethnicity
Max. file size: 128 MB.
If required per the award application information.
Max. file size: 128 MB.

Please upload two nomination letters below (one to two pages each). The letters should highlight the nominee’s accomplishments and explain why the nominee is deserving of the award. The letters can be written by you, a supervisor and/or a colleague.

Max. file size: 128 MB.
Max. file size: 128 MB.
Max. file size: 128 MB.
Max. file size: 128 MB.

Only fill out this section if you are nominating a colleague

Full Name of Nominator if Different from Nominee
Address
*The APA defines URM using the AAMC's 2004 definition: "Underrepresented in medicine means those racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population," which includes the following racial and ethnic groups: Black or African American, Hispanic/Latino, Native American or Alaskan Native, Native Hawaiian and other Pacific Islander.
Ethnicity

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  • Soliciting Nominations for APA 2024 Election May 9, 2023
  • 2023 Election Results April 14, 2023
  • Announcing the 2023 George Armstrong, Miller Sarkin, Pillar, Abstract and YIA Awardees! April 14, 2023
  • 2023 QI Conference – Register Today! April 13, 2023
  • 2023 PHM Call for Award Nominations April 11, 2023

Recent Posts

  • Soliciting Nominations for APA 2024 Election
  • 2023 Election Results
  • Announcing the 2023 George Armstrong, Miller Sarkin, Pillar, Abstract and YIA Awardees!
  • 2023 QI Conference – Register Today!
  • 2023 PHM Call for Award Nominations

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  • Groups & Networks
    • Regions
    • Special Interest Groups
    • Research Networks
      • BORN
      • CORNET
      • PRIS
    • Committees
    • National Academy of Distinguished Educators in Pediatrics (NADEP)
    • Online Community
  • Programs & Awards
    • Faculty Development Programs
    • Research Funding Programs
      • RAPID Scholar Awards
      • Young Investigator Awards Program
    • Catalyst Career Development Program
    • Fellowships
      • Applying for a Fellowship Program
      • Fellowship Program Accreditation
    • Mentorship Programs
      • New Century Scholars Resident Mentoring Program
      • RAPID Mentoring and Career Development Conference
      • Speed Mentoring
      • NADEP UIM Mentoring Program
    • Awards
  • Journal & Resources
    • Academic Pediatrics Journal
    • News & Blog
    • Connect Mobile App
    • Anti-Racism & Equity Toolkit
    • Job Board
    • APA Resources by Career Level
  • Meetings & Events
    • Event Calendar
    • Pediatric Academic Societies (PAS) Meeting
    • Pediatric Hospital Medicine (PHM) Meeting
    • Regional Meetings
    • Fellows Meeting
    • QI Meeting
  • Advocacy
    • Pediatric Policy Council
  • About
    • Mission and Vision
    • Membership
      • Join APA
    • Staff
    • Board of Directors
    • Strategic Plan
    • Contact
  • Join
  • Renew
  • Online Community
  • Job Board
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  • Contact

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