Nomination Form for Research in Minority Health Award

100% of survey complete.

The purpose of the Research in Minority Health Award is to recognize the contributions of an individual or group conducting and/or promoting research that has significance for improving the health care of minorities and other under-represented groups in the Southern region.

NOTE: Nominator must be an SNRS member.

Full Name of Nominee and Credentials:

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* 1. Full Name of Nominee and Credentials:

Current Position:

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* 2. Current Position:

Current Employer:

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* 3. Current Employer:

Employer Address:

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* 4. Employer Address:

Nominated by:

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* 5. Nominated by:

SNRS Membership Number:

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* 6. SNRS Membership Number:


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* 7. Address:

The Nomination Packet must include the following:

1.  A letter of nomination (self-nominations accepted) which outlines how the nominee meets the award criteria.

2. Two letters of support.

3. A completed Nomination Form.

4. Signed Nominee Consent Form to attend the Annual Conference to receive the award. Must be in electronic form or PDF.

5. The nominee's full Curriculum Vitae.

6. Electronic copies of two published or in-press research articles.

Once you click "Done" you will be returned to the SNRS website; click the link there to submit the information above.