Humanitarian Award

A substantial medical volunteer contribution by an individual, organization, or exhibitor which is medically related and has a positive impact on a national or international cause or event will be recognized. Nominees must be members of UCAOA. Before filling out the form, please ensure that the nominee meets the following criteria:

Nominees Must be members of UCAOA
Nominees must be able to verify acts of service actually happened
Nominees services must make national or international impact
Nominees cannot be current Awards Committee Members and Board Directors

Instructions

All required fields are marked with a red asterisk (*)
Any field name that is underlined has additional instructions/details
Please do not nominate one person for multiple categories. The Awards Committee can determine if the nominee is eligible for more than one award.
Deadline to Nominate: 5pm on Wednesday, February 17, 2016
If you have questions, please email them to rreed@ucaoa.org

Who do you nominate for this award *Write the first and last name of the person you would like to nominate for the Humanitarian Award. If you want to nominate an organization please write the organization name.
Why does the nominee deserve the award? *Explain why the nominee deserves the Humanitarian Award. Please include how this candidate meets the criteria needed for this award. You may also attach documents, photos, and links in the next field.
Attachments Please upload any photos or documents helpful to the selection process. Photos may be used in future marketing and presentation of awards.
Nominee Phone *
Nominee Email Address *
Nominator Name *If you are the nominator please enter your first and last name. If this is a self nomination, please write self into the field.
Nominator Phone *
Nominator Email Address *
Reference Name *Please write down at least one reference who can provide additional information regarding the nomination.
Reference Phone *
Reference Email Address *