Elizabeth Noble Award Nomination Form

2021 Elizabeth Noble Award

The Award Recipient will be selected in 2021 and the award is to be presented during the 2022 Combined Sections Meeting week in San Antonio, TX.

The Academy of Pelvic Health Physical Therapy (APTA Pelvic Health) will be recognizing and celebrating volunteers and industry partners that have helped support our Academy and strategic goals in 2022 February at the Annual Business Meeting in San Antonio, Texas. We invite you to nominate an Academy member in good standing who you think deserves to receive the 2021 Elizabeth Noble Award.

Elizabeth Noble was the founder of the Academy of Pelvic Health Physical Therapy (previously called the Section on Obstetrics and Gynecology and Section on Women's Health). She served as the first Chair and was a driving force behind the development of the field of obstetric and gynecological physical therapy in the United States. She was the author of multiple books for both the lay public and the professional.

The Elizabeth Noble Award is the Academy of Pelvic Health Physical Therapy's highest honor, and is given to an Academy member providing extraordinary and exemplary service to the field of physical therapy or to the Academy.

The award may be, but is not necessarily, presented on an annual basis. When awarded, the recipient is presented with the award at the Annual Business Meeting.

Nominee Eligibility Requirements:

Current Academy member in good standing
Member who provides extraordinary and exemplary service in the physical therapy field or to the Academy

Nomination Form Requirements:

All fields in this form must be completed.
2 Support Letters from individuals who also advocate the nominee’s selection. The Nominator must distribute the Support Letter template to those individuals and collect them in time for submission of the Nomination Form. Click to download Support Letter Template and share with your colleagues.

DEADLINE EXTENSION: All forms and letters should be submitted through this form by 11:59pm Eastern Time, December 1, 2021.

Sender

Nominee's Full Name (the person you are nominating) *

Nominee's Designation/Credentials (Optional and only if you know it)

Nominee's E-mail Address *

Nominee's Phone Number *

Area Code Phone Number

Instructions: Please limit your word count and avoid repetition wherever possible.

Describe the individual’s contributions to the field of pelvic health physical therapy. *

Describe the individual’s contributions to the Academy of Pelvic Health Physical Therapy *

Help Text: i.e. Writing a book, doing research, leave a legacy, being a clinical instructor

Describe the individual’s qualifications, achievements and leadership roles on a local, national or international level. *

Help Text: i.e. volunteer service, advocacy for the profession

List 3 words that best describe this individual that make them exceptional in your view. *

Help Text: i.e. volunteer service, advocacy for the profession

How does this individual demonstrate exceptional qualities? *

Help text: We all care about what we do, many of us volunteer but how does this person stand out i.e. supports mission above self

How does this individual demonstrate exemplary behavior and how has it impacted their patients and the community? *

Help text: i.e. how does this individual raise the bar?

How does this individual pave the way for the next generation of physical therapy professionals? *

Help Text: i.e. Motivates other physical therapists, guides others, educates others

How does this individual draw positive public attention to pelvic health physical therapy? *

2 Letters of Support

2 Support Letters from individuals who also advocate the nominee’s selection. The Nominator must distribute the Support Letter template to those individuals and collect them in time for submission of the Nomination Form. Click to download Support Letter Template and share with your colleagues.

Responses need not be lengthy. All letters should be typewritten for clarity. Please include in the support letter(s) the nominee’s contributions to the field of physical therapy and to the Academy of Pelvic Health Physical Therapy.

Upload Support Letter #1 *

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Upload Support Letter #2 *

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Your Contact Information

Nominator's Information

Nominator's Name: *

First Name Last Name

Nominator's E-mail Address: *

example@example.com

Please initial or sign below using your mouse cursor. If you are using a mobile or tablet device, please use your finger to sign below. Thank you! *

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