2025 MOA Award Nomination Form

Please submit one form per nomination. Nominee must be a MOA member to be considered for award.

Have multiple nominations? Please submit a separate form for each nomination.

Practice Name

City/Town

Email Address

Phone Number

Practice Name (if known)

City/Town (home or work if known)

Email Address (if known)

Phone Number (if known)

Optometrist of the Year

Young Optometrist of the Year

Roger R. Seelye Distinguished Service Award

Keyperson Award

Educator of the Year - to be nominated by MCO students only

Student of the Year - to be nominated by MCO faculty only