2022 NCICP Award Nominations

2022 National Conference for Immunization Coalitions and Partnerships (NCICP) Award Nominations:

NCICP is excited to host the first ever Immunization Recognition Awards! Please complete the brief nomination form below to nominate an immunization champion who is passionate about vaccines and has worked to increase immunization rates in their community!

There are 5 categories (Immunization Leadership, Equity in Immunization, Excellence in Immunization Advocacy, Excellence in Immunization Collaboration, and Emerging Leader); if you would like to nominate more than one person, or nominate the same person for multiple awards, please re-submit the form for each nomination. Self-nominations are welcome, and awards will be given out at the NCICP Conference in Minneapolis September 13-15th. The awards luncheon is tentatively scheduled for Tuesday, September 13th at 12:30. Winners do not need to be present (although we’d love to see you in person!) to accept their award.

Nominations will be accepted through June 30, 2022

If you have any questions about the nomination form or the awards, please email: heather@immunizear.org

Question Title

* 1. Who are you nominating?

Name

Organization/Agency

Role/Title

What state coalition is nominee affiliated?

Address

Address 2

City

Zip

State

Email Address

Phone Number

Question Title

* 2. Category for Nominee (only choose one)

Immunization Leadership Award - Nominee is considered an expert on immunizations in their community. An individual who goes above and beyond or does an exemplary job to promote or foster immunizations. · Activities may include acting as a spokesperson, trainer, mentor or educator.

Equity in Immunization Award - Nominee uses creative or innovative strategies to promote immunization equity or addresses challenges to immunization. Activities may include both new strategies and adapting existing strategies in new ways to reach under-immunized population.

Excellence in Immunization Advocacy · Nominee is active in advancing policies to support immunization in their community, state, or region. Activities may include but not limited to providing legislative testimony, built and/or coordinated the development of a group of grassroots advocates, submitted press releases, utilized social media to educate on bills and deliver a call to action, provided advocacy training, etc.

Excellence in Immunization Collaboration - Nominee is recognized for being a collaborator who dedicates their time and talent to build partnerships with community members, organizations, and institutions to build a common agenda to solve complex problems that make a collective impact.

Emerging Leader Award - Nominee is an individual or organization with five (5) years or less experience working in the immunization field, who has demonstrated their potential through outstanding service and contributions and has made innovative contributions to their field.

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* 3. Will the nominee attend the NCICP Conference?

Yes

Unsure

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* 4. Describe how nominee fits the criteria for this award. (Limit to 250 words - no CV's/resumes, please)

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* 5. How is the nominee engaged with their coalition? (Limit to 250 words)

Question Title

* 6. Nominator (Your) Information

Name

Organization/Agency

Role/Title

Address

Address 2

City

Zip Code

State

Email Address

Phone Number

Relationship to Nominee

2022 NCICP Award Nominations