Award Nomination Details

Nomination Process

Please nominate using the official form below.

Nomination packets should also include:

  • A letter from the nominator describing the most important achievements of the nominee and explaining why the nominee meets the criteria for the award.
  • Two supporting letters must signed by their authors. Emailed letters must contain an electronic signature.
  • A current curriculum vitae or a detailed resume of the nominee.

Nominations should not be sent in notebooks, binders or folders. Incomplete nominations will be returned to the nominator for correction and resubmission before the deadline. Nominations submitted via email must be received by deadline date. Send the nominations via email to debrajackson@mweb.co.za by the deadline date - May 10, 2013.

Nomination Form

2013 Maternal and Child Health Awards

NOMINEE INFORMATION

Full Name:

Award Intended:

Degree(s):

Title:

Organization:

Mailing Address:

City State Zip Code:

Telephone Number:

Fax Number:

Email:

NOMINATOR INFORMATION

Full Name:

Title:

Organization:

Mailing Address:

City State Zip Code:

Telephone Number:

Fax Number:

Email:

Signature:

Date:

(Please print or type)

Describe below in detail the current creative work, distinguished achievements, or distinguished service which make this nominee worthy of the award, bearing in mind the description:

 

 

Position(s) (title and dates) held during performance of work for which nomination is suggested:

 

 

Publication(s) relevant to particular achievements on which nominations is based:

 

 

Other honors and awards:

 

PLEASE EMAIL TO: debrajackson@mweb.co.za