2024 Connie San Andres-Robles ON DPG Distinguished Service Award Application
Please complete the following application by EOD May 15, 2024.
Name
*
First Name
Last Name
Academy ID Number
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Please answer the following questions:
How many years have you been a member of ON DPG?
*
How many years have you participated in ON DPG committees, appointed positions, or elected positions within the ON DPG:
*
Please list ON DPG positions held. Include elected, volunteer, and appointed positions.
*
Please list your contributions to ON DPG. e.g. were you an author on a publication, did you chair one of the ON Symposiums or work on a symposium committee etc.
*
Describe how you have promoted the ON DPG through involvement in the Academy, other oncology and nutrition associations, along with local, state or national programs. Include activities that promote the oncology dietitian through public policy, licensure, or certification.
*
Describe your professional responsibilities in the field of oncology nutrition and list the number of years in the profession.
*
Provide any other activities you have been involved with that impact oncology nutrition practice.
*
Please attach a recent CV/resume that includes your presentations and publications from the past 10 years.
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Please attach a letter of recommendation.
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Submit
Should be Empty: