NOMINATION FORM: 2026 Bernard Lown Award for Social Responsibility

To honor Dr. Lown’s memory, and because our society needs more leaders like him, we created the Bernard Lown Award for Social Responsibility. The BLASR is given each year to a young clinician who demonstrates bold leadership in social justice, health care reform, environmental justice, global peace, or other humanitarian efforts, and comes with a $25,000 prize.

To be eligible, candidates must:

-be aged 45 or younger
-be a clinician in the United States
-stand out for their bold leadership in social justice, health care reform, environmental justice, global peace, or other humanitarian efforts

Nominations will be accepted through January 15, 2026.

For more information, visit the award website or contact us at LownAward@LownInstitute.org

Question Title

* 1. Nominator Information

Your name*

Your email address*

Your phone number

Relationship to nominee (if any)

Your job title

Your organization

Question Title

* 2. Nominee information

Nominee's name*

Nominee's email

Nominee's phone number

Nominee's LinkedIn

Nominee's job title

Nominee's organization*

Question Title

* 3. Do you want us to keep your nomination anonymous?

Yes, please keep me anonymous

No, you may tell others I was a nominator

Question Title

* 4. Eligibility (must select all three to be eligible)

Is your nominee a clinician working in the United States?

Will your nominee be 45 years old or younger on June 7, 2026?

Has your nominee taken on professional or personal risk to do their work?

Question Title

* 5. Tell us why you are nominating your candidate for the Bernard Lown Award. Describe a specific activity/accomplishment undertaken by the candidate that supports their nomination. (250 words maximum)

Question Title

* 6. Describe an additional activity/accomplishment undertaken by the candidate that supports their nomination. (optional - 250 words maximum)

Question Title

* 7. Describe an additional activity/accomplishment undertaken by the candidate that supports their nomination. (optional - 250 words maximum)

Question Title

* 8. Bold leadership in advancing social responsibility often requires taking personal and professional risk. Previous winners have risked their career bringing evidence of a city's tainted drinking water to public attention or taken a position at the front lines of securing health justice for immigrants. Describe how this applies to your nominee. (100 words maximum)

Question Title

* 9. Upload a CV or list of achievements. (optional but highly encouraged)

PDF, DOC, DOCX, PNG, JPG, JPEG file types only.

Choose File

Question Title

* 10. Upload a newspaper article or other published piece about your nominee. (optional)

PDF, DOC, DOCX, PNG, JPG, JPEG file types only.

Choose File

Question Title

* 11. Upload a piece written by your nominee or a similar document sharing your nominee's abilities. (optional)

PDF, DOC, DOCX, PNG, JPG, JPEG file types only.

Choose File

Question Title

* 12. Is there anything else you'd like us to know about your nominee?

Question Title

* 13. How did you hear about the Bernard Lown Award for Social Responsibility?

Lown Institute email

Lown Institute website

Social media

Colleague or friend

Other (please specify)