Humanitarian Award

Awarded for significant medical volunteer work by an individual, organization, or exhibitor which has a positive impact on a national or international cause or event. Nominees must be members of UCAOA.

Before completing the form, please ensure that the nominee meets the following criteria:

Nominee must be a member of UCAOA
Nominee must verify/provide proof of acts of service
Nominee's services must have made a positive impact at a national or international level
Nominee cannot be a current member of the UCAOA Awards Committee nor Board of Directors

Instructions

All required fields are marked with a red asterisk (*)
Any field name that is underlined has additional instructions/details. Position your cursor over the underlined questions to view 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: November 20, 2017
If you have questions, please send an email to nshah@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 Innovation 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 Innovation 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 *