APHL 2016 LIFETIME ACHIEVEMENT AWARD

Transcription

1 APHL 2016 LIFETIME ACHIEVEMENT AWARD Nominations Form DEADLINE FOR SUBMISSIONS IS FEBRUARY 29. Complete and return to Drew Gaskins at

2 Lifetime Achievement Award This award recognizes individuals who have established a history of distinguished service to APHL, made significant contributions to the advancement of public health laboratory science or practice, exhibited leadership in the field of public health, and/or positively influenced public health policy on a national or global level. Nominations should be made from a broad field of candidates (a minimum of three nominators). This is not a retirement award, but a true Lifetime Achievement Award. Only current APHL members are eligible to be nominated for this award. Please see the additional instructions at the end of this form. For a list of past award winners, click here. 1. Nominee for award: Name (include salutations, degrees): Full Title/Position: Organization: Address: Telephone: Fax: 2. Nominated by: **In the case of more than three nominators, please submit additional documentation with your form and follow the format provided** Nominator #1 Name (include salutations, degrees): Full Title/Position: Organization: Address: Telephone: Fax:

3 Nominator #2 Name (include salutations, degrees): Full Title/Position: Organization: Address: Telephone: Fax: Nominator #3 Name (include salutations, degrees): Full Title/Position: Organization: Address: Telephone: Fax:

4 3. Instructions: All four questions listed below must be addressed. In the space provided, please give a description of the nominee s accomplishments that addresses the questions in a thorough manner. The Membership and Recognition Committee invites specific details on the work history of the nominee. The committee cannot consider any qualification or achievement that is not included in the nomination materials. Bullet points are acceptable for the first three questions.

5 1. Discuss the nominee s history of service to APHL. In particular, list positions of leadership held within the association, such as terms as Officer or member of the Board of Directors or chair or member of committees. Include any other known association history, such as participation on committees, subcommittees and workgroups, and any examples of the nominee representing APHL officially as a liaison to other organizations or at national meetings.

6 2. Discuss the nominee s significant contribution(s) to the advancement of public health laboratory science or practice. Be as specific as possible by listing teaching positions or academic appointments; awards or honors from professional or scientific organizations or institutions (provide name of award/honor and date given, if known); citations of scientific papers, book chapters, etc., in which the nominee was an author; or positions as editor or author of a scientific or public health periodical(s) or book(s). Provide listing of presentations including poster presentations in which nominee is listed as an author.

7 3. Provide examples including years of service of the nominee s leadership in the field of public health including, but not limited to, examples of positively influencing public health policy on a national or global level. (Government committees and workgroups, testimony to Congressional committees, advocacy for public health laboratories and science, senior positions in health fields, other public health committee participation.)

8 4. In your evaluation, how did the nominee s contributions support the advancement of public health laboratories? (For example: outreach, national standards development, advocacy, accreditation, etc.) **Please answer with 500 words or less in an essay-style format**

9 Additional Instructions Lifetime Achievement Award Nomination Requirements - Nominators must be a member of APHL. - Nominees must be a member of APHL. - Three or more members of APHL must nominate the individual confidentially. - An individual may not be self-nominated. - Members of the Membership and Recognition Committee and Board of Directors may nominate, second or be a candidate for the Lifetime Achievement Award. Nominators and nominees shall not participate in deliberations for these awards. - The Membership and Recognition Committee will review all nominations; its recommendation will be considered and decided upon by the Board of Directors. Nomination Directions - Include the complete name, address, and phone number of the nominee. - Include the complete name, address, and phone number of the three APHL members supporting this nomination. - The Membership & Recognition Committee strongly encourages submission of the CV of the award nominee. General Nomination Rules - Current board members are not eligible to receive an award - APHL staff are not eligible to nominate or receive an award Past Award Winners For a full list of past award winners please visit the awards page on APHL's website.