Please use the form below to tell us about a physician you think is deserving of this award.
The physician must be a Wisconsin resident.
The physician must be a medical doctor (MD) or doctor of osteopathy (DO).
The physician must be involved in a program of the Foundation or a project supported by the Foundation through a grant or other partnership.
Previous winners of the award are not eligible.
Additional letters of recommendation are encouraged. These may be from physicians, patients, community leaders, etc. that help demonstrate the nominee's activities and values. Additional letters of support can be uploaded with the application or emailed to email@example.com.