2026 PA of the Year Nomination Form

Qualifications: The candidate must be an IPAS member and serve the Iowa community.

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1. Your Name - (The Person Submitting the Form)

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2. Your Email Address (The Person Submitting the Form)

Nominee Information

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3. Name

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4. Email

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5. Mailing Address

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6. Place of Practice: (Required.)

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7. PA Program Nominee Graduated From: (Required.)

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8. Please provide a paragraph stating why you believe this person should be PA of the Year: (Required.)