Student Award Recipient Nomination Form

Student Award Recipient Nomination Form

**Please complete this recipient information form AT LEAST 3 weeks prior to your award ceremony to ensure there is ample time for staff to mail your materials. Please contact us at info@aavd.org with any questions or concerns.**
The student award winner will receive:
- $400 cash prize (pending submission of included W9/8233)
- A congratulatory letter from the AAVD Board
- A framed certificate
- 2 years of membership with the AAVD ($50 per year value)
- Reduced registration fee to the North American Veterinary Dermatology Forum (NAVDF) as an AAVD member
- Free receipt of the AAVD Newsletter Derm Dialogue
These items may be sent to the school to give at your award ceremony or may be sent directly to the award winner. You will select the chosen location below.
Student/Award Recipient's Name:*

First NameLast Name
Student/Award Recipient's Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student/Award Recipient's PERSONAL email (NOT university email, unless keeping after graduation):*
example@example.com
Date of Award Ceremony:

MonthDayYear
Date
Veterinary School:*
Veterinary School's Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Veterinary School Contact's Name:*

First NameLast Name
Veterinary School Contact's Address (if different from school address):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Veterinary School Contact's Phone Number*
Please enter a valid phone number.
Veterinary School Contact's Email:*
example@example.com
Mail Award Certificate/Monetary Award to:*

Veterinary School ContactDirectly to Student/Award Recipient
Comments (optional):
By signing you are verifying you have reviewed all information submitted on the form and verify the information is correct.*

Clear
**Please complete this recipient information form AT LEAST 3 weeks prior to your award ceremony to ensure there is ample time for staff to mail your materials.

Please contact us at info@aavd.org with any questions or concerns.**
Should be Empty: