CONACH Native American Child Health Advocacy Award Nomination Form (Rolling)

Nomination Form

Each year, the AAP Committee on Native American Child Health presents the Native American Child Health Advocacy Award to recognize an individual who has made a major contribution to Native American child health and exemplifies a lifelong commitment, equal to or greater than 10 years of service, to Native American children and their communities. This award recognizes a physician or non-physician. Please use this survey to submit nominees. For consideration for the next award, nominations must be completed by December 22nd.

Nominations submitted after that date will be held for the next year.

Nominations from a spouse, partner, or family member are not permitted.

For information about past award winners, visit https://www.aap.org/conachaward.

If you have any questions, please contact Ngozi Onyema-Melton at indianhealth@aap.org or 630-626-6184.

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* 1. Please enter the NAME and contact information of the person submitting the nomination.

Name *

Email Address *

Phone Number

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* 2. Please indicate the award cycle year here (e.g. 2024, 2025, etc.)

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* 3. Are you nominating a spouse, partner, or family member?

Yes

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* 4. Please enter the name and demographic information of the person being nominated.

Name *

Address

Address 2

City/Town

State/Province *

ZIP/Postal Code

Email Address *

Phone Number

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* 5. Please tell us why you feel the nominee should receive this award.

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* 6. Please include the nominees biosketch and/or any additional supporting materials via a file upload.

In the event that you are unable to upload a file, please email the document(s) to Ngozi Onyema-Melton at indianhealth@aap.org by December 22.

Your nomination will not be considered complete until the biosketch and/or other supporting materials are received. Thank you!

Paste biosketch and/or other supporting materials here:

PDF, DOC, DOCX, PNG, JPG, JPEG file types only.

Choose File