Advisory Council on Parkinson's Research, Care, and Services Nomination Form

OMB#: 0925-0766 Expiration date: Wed Sep 30 00:00:00 EDT 2026
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Nominations
NIH is soliciting nominations for members of the Advisory Council with expertise as specified in the Dr. Emmanuel Bilirakis and Honorable Jennifer Wexton National Plan to End Parkinson’s Act (P.L. 118-66). This includes two Parkinson’s patient advocates, at least one of whom is living with young-onset Parkinson’s; one Parkinson’s family caregiver; one health care provider; two biomedical researchers with Parkinson’s related expertise in basic, translational, clinical, or drug development science; one movement disorder specialist who treats Parkinson’s patients; one dementia specialist who treats Parkinson’s patients; and two representatives from nonprofit organizations that have demonstrated experience in Parkinson’s-related research or Parkinson’s-related patient care and other services. To learn more about the committee and what will be required of committee members please visit (https://www.ninds.nih.gov/current-research/trans-agency-activities/national-plan-end-parkinsons).

This webform is intended to standardize the nomination process, increasing efficiency and fairness. Nominees will be evaluated based on letter of support, CV and the following criteria: 1) Leadership; 2) Public service; 3) Parkinson’s-relevant publication record (if applicable); 4) Clinical activities (if relevant) 5) Funding record (if applicable); 6) demonstrated ability to represent the broader Parkinson’s community’s needs.

Individuals and organizations may submit multiple nominations by submitting multiple webforms. Individuals may self nominate.

The Department strives to ensure that the membership of HHS Federal advisory committees is fairly balanced in terms of points of view represented and the committee's function. Every effort is made to ensure that the views of diverse ethnic and racial groups and people with disabilities are represented on HHS Federal advisory committees, and the Department therefore, encourages nominations of qualified candidates from these groups. The Department also encourages geographic diversity in the composition of the Committee. Appointment to this Committee shall be made without discrimination on the basis of age, race, ethnicity, gender, sexual orientation, disability, and cultural, religious, or socioeconomic status.

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* 1. Nominee's First Name

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* 2. Nominee's Last Name

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* 3. Nominee's Email Address

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* 4. What is the nominee's race/ethnicity (Select all that apply) ?

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Middle Eastern or North African

Native Hawaiian or Pacific Islander

White

Other

Prefer not to respond

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* 5. Is the nominee: (Mark all that apply)

Female

Male

Transgender, non-binary, or another gender

Prefer not to respond

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* 6. Nominee's Degree(s) (if applicable):

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* 7. Nominee's Title (if applicable):

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* 8. Nominee's Organization (if applicable):

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* 9. Nominee's State of Residence:

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* 10. Nominee's Area(s) of Expertise (Mark all that apply)

Parkinson’s patient advocate

A person living with young-onset Parkinson's

Parkinson’s family caregiver

Health care provider

Biomedical researcher with Parkinson’s- related expertise in basic, translational, clinical, or drug development science

Movement disorder specialist who treats Parkinson’s patients

Dementia specialist who treats Parkinson’s patients

Representatives from nonprofit organizations that have demonstrated experience in Parkinson’s-related research or Parkinson’s-related patient care and other services

Other (please specify)

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* 11. Nominee's experience relevant to participation on this advisory council such as leadership, public service, lived experience of Parkinson’s disease or neurodegenerative Parkinsonisms, experience providing health care, and/or research experience? (Please limit reponses to 5,000 characters)

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* 12. Please attach nominee's CV/resume

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

Choose File

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* 13. Please attach a letter of support for the nominee

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

Choose File

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* 14. Are you nominating yourself? If you respond "Yes", the survey will end after this question.

Yes