BCoD Patient Impact Award Nomination Form

BCoD Patient Impact Award Nomination Form
Thank you for submitting a nomination for the BCoD Patient Impact Award. This award recognizes biologic coordinators and dermatology professionals who have created measurable, positive change for patients with dermatologic conditions through exceptional patient advocacy, access, care coordination, and clinical impact.
Please complete all required fields and upload the requested supporting materials.
Submission Deadline: August 14th, 2026

Nominator Information
Full Name

First NameLast Name
Email Address
Phone Number
Optional. Please provide a phone number if available.Format: (000) 000-0000.
Organization / Employer
Are you nominating yourself?
Relationship to the Nominee
(If nominating yourself, please disregard.)

Nominee Information
Nominee Full Name

First NameLast Name
Nominee Email Address
Nominee Phone Number
Optional. Please provide a phone number if available.Format: (000) 000-0000.
Current Position / Job Title
Organization / Employer

Resume / CV Upload

(Maximum three pages)
Please submit a current CV or resume highlighting relevant experience and accomplishments.
Upload files below.

Cancelof

Additional Comments
Please provide any additional information you would like the review committee to consider, if applicable.
Should be Empty:

Nominator Information