Please fill out the form below to nominate a meritorious individual for the Physician Assistant Citizen Award. You may also email your nomination to awards@theoma.org if you prefer. If you have any questions, please email Kris Bilderback, Executive Assistant to the CEO, at kris@theoma.org. Additional information about our awards can be found here: OMA Awards

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* 1. Please provide your contact information

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* 2. Please provide the contact information of the nominee

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* 3. PA-Citizen Award: The PA-Citizen Award will recognize a physician assistant who has generously donated their time to community activities and who exemplifies the highest values of a patient-centered, team-based medical practice. Awardees will demonstrate outstanding volunteer service to their local community, going above and beyond the call of duty in the practice of medicine in providing care for patients as a collaborative partner of a clinical team, and as a champion in advancing professional opportunities for physician assistants.

Please explain why your nominee is deserving of this award. Specific examples of professional and civic accomplishments will assist the selection committee in identifying the award recipient.

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* 4. Please attach a bio, resume, or CV for your nominee.

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* 5. Alternate: Paste a bio or CV here

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