2019 Award Nominations 

View award details at www.apaog.org/awards. 

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* 1. Award Proposed:

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* 2. Nominee First Name

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* 3. Nominee Last Name 

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* 4. Nominee Address including City, State and ZIP Code 

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* 5. Nominee Organization/Affiliation (If nominee is a student, list PA
Program)

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* 6. Nominee's Current Title/Position

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* 7. Nominee Phone Number

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