NOMINATION FORM

Please complete the below questions to submit a nomination for the 2022 US HUPO Distinguished Contribution Award. The award application must be completed in full to be considered, so please ensure you have all the required documents prior to submitting. 

Nominations will be held for three years. The deadline for submission is Monday, November 29, 2021. 

Eligibility
The nominee must be a current US HUPO Member.
The awardee must be available to present at the annual conference (February 28 - March 2, 2022) in Charleston, South Carolina to receive the award and present the lecture.

Instructions and
Deadlines

Please collate all materials, including the required supporting letters, into a single PDF prior to uploading. The PDF should include the following documents: 
1) Short description from the nominator on the unique contributions made by the nominee (one-page maximum).
2) List of key publications that support the contribution and nomination.
3) Two letters of reference supporting the nomination. 


The nomination form must be completed in its entirety to be considered. Incomplete applications will not be reviewed.

The deadline to submit a nomination is Monday, November 29, 2021. Late applications will not be reviewed. Award notifications will be sent to recipients and nominators on December 13, 2021. 

Question Title

* 1. Nominator Information

Question Title

* 2. Nominee Information

Question Title

* 3. If the nominee's location is outside of the US, please provide details on their involvement with US HUPO. 

Question Title

* 4. Upload your nomination documents & supporting letters:

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

T