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CACN Henry Dunn Lifetime Achievement Award Nomination Form

The award recognizes a senior CACN member for their contributions to the development of child neurology research and education in Canada and their nationally and internationally recognized career achievements in the field of child neurology.

Nominations can be submitted by any CACN member and should include a letter of support outlining the nominee’s career contributions to child neurology and the nominee’s curriculum vitae, if available.

Nominations can be submitted at any time with an annual deadline of January 31st. Nominations will be reviewed by a committee of the CACN Executive. Please contact CNSF Member Services with any questions membership@cnsf.org.

The winner will be invited to attend the CNSF Congress where the award will be presented at the annual CACN dinner.

Awarded annually

Terms of Reference
NOMINEE INFORMATION
1.Full name(Required.)
2.Position/Title(Required.)
3.Institution/practice(Required.)
4.City and Province(Required.)
5.Email(Required.)
NOMINATOR INFORMATION
6.Nominator full name(Required.)
7.Email(Required.)
8.Relationship to nominee(Required.)
9.Confirmation of eligibility(Required.)
10.Confirmation of criteria met
Check all that apply. (Required.)
11.Nomination statement
Briefly summarize the nominee's career contributions to child neurology research and education (full details to be attached in a letter of support)(Required.)
12.Upload a letter of support describing the nominee's career contributions(Required.)
No file chosen
13.Upload the nominee's curriculum vitae (if available)
No file chosen
14.Nomination and submission confirmation(Required.)