Skip to content
2026 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.
*
1.
My name
(Required.)
*
2.
My contact information
(Required.)
Practice Name
City/Town
Email Address
Phone Number
*
3.
Name of nominee
(Required.)
4.
Nominee's contact information
Practice Name (if known)
City/Town (home or work if known)
Email Address (if known)
Phone Number (if known)
5.
Award nominating for (select one)
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/UDMSO students only
Student of the Year - to be nominated by MCO/UDMSO faculty only