2023 VAPAA Excellence Awards Nomination Form
Your Name
*
First Name
Last Name
Your Email Address
*
Please do not use your VA email.
Your Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
About The Nominee
Nominee Name
*
First Name
Last Name
Credentials
VA Clinic Location
*
Nominee's Email
*
If possible, please do not use a VA email.
Please describe how the nominee demonstrates excellence in each of the following categories.
Nominees will be scored in all the following areas. Identifying information regarding the nominee will be redacted upon presentation to the Awards Subcommittee. To assist with this, please refrain from using the nominee's name below.
Enhancement & advocacy of the PA profession and image
Dedication to quality medical care
Leadership
Involvement in VAPAA, AAPA, local/state/regional PA organizations
Education/preceptorship
Research/Publications
Is there anything else you would like to include about the nominee.
If you would like, you can attach a letter of recommendation to this application.
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