Skeffington Alexander Award 2024 Nomination Form

Skeffington Alexander Award 2024 Nomination Form
This form allows you to nominate an outstanding optometrist for the Skeffington Alexander Award 2024 at ICBO. The award recognizes exceptional contributions to the field of optometry, particularly in behavioral optometry, vision therapy, and related areas.
Eligibility Criteria:
To be eligible, the nominee must:
Is the nominee a licensed optometrist in good standing?
Is the nominee a clinical associate of OEPF or affiliated with an organization aligned with OEPF's mission (Specify organization if applicable)
Does nominee have a minimum of 10 years of experience in optometry?
Years of experience
Nomination Information:
Nominee Information:
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Nominator Information:
Name

First NameLast Name
Relationship to Nominee:
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Nomination Details:
Please fill in the text boxes or upload the following documents in support of your nomination:
Nominee's Professional Biography - A detailed account of the nominee's background, career highlights, and achievements.
File Upload

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Description of Contributions to Optometry - Explain the nominee's significant contributions, especially in behavioral optometry,vision therapy, or related areas. (Research, innovations, publications, service initiatives)
File Upload

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Supporting Documentation - Provide evidence to substantiate the nominee's qualifications, such as: Publications (research papers, articles), Awards and recognition, Letters of recommendation, Public service initiatives
File Upload

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Deadline:
All nominations must be submitted electronically by June 30, 2024.
Additional Selection Criteria:
An OEPF committee will review nominations based on the following criteria:
Professional Achievements - Explain accomplishments:
Innovative Contributions - Describe impact on the field:
Leadership and Mentorship - Evidence of leadership and commitment to mentoring:
Community Involvement - Describe engagement in community service initiatives:
Ethics and Professionalism - Explain adherence to high ethical standards:
The committee may shortlist top candidates for interviews. The final selection will be made by the committee and approved by the OEPF board.

Award Presentation
The award will be presented at the 2024 ICBO on behalf of OEPF. The recipient will receive a commemorative plaque and recognition in OEPF publications and media. They may also be invited to deliver a presentation at a future event.

Post-Award Engagement
The recipient is encouraged to maintain a connection with OEPF through participation in conferences, mentorship programs, or speaking engagements.

Thank You
Thank you for nominating a deserving optometrist for the Skeffington Alexander Award!
Should be Empty:

Eligibility Criteria:

Nomination Information:

Nomination Details:

Deadline:

Additional Selection Criteria: