2024 Innovation & Excellence in Behavioral Health & Addiction Medicine Award Form

Nominator Information

The completed nomination form, nominee’s curriculum vitae and letters of support must be submitted electronically, preferably in Word format, no later than March 12, 2024, to be considered by the Pain Management & Addiction Medicine Section. Up to three letters of support for the nomination may also be submitted. Letters of support are greatly encouraged and are at the discretion of the nominator. The letters of support should explain why the nominee merits the award and specifically relate the nominee’s background to the award criteria. Please also submit any letters of support in Word format.

Receipt of each nomination will be confirmed by e-mail. Please follow up with Sam Shahid if you do not receive a confirmation.

This form must be completed entirely. Do not indicate "see C.V."

Nominee

Note: You can upload multiple letters of support after clicking the "Choose Files" button, simply select multiple files once the window opens.