Thank you for taking the time to nominate a fellow alumnus for our new Distinguished Alumni Award!

We hope you and your nominee will join us September 14 at the Albuquerque Country Club to celebrate our inaugural Distinguished Alumni Award recipient and the 20 year anniversary of your PA program.
 
Please respond to as many of the below fields as you are able and THANK YOU for your nomination.

Nominee Name and Class Year

Question Title

* 1. Nominee Name and Class Year

Email and/or phone number of nominee

Question Title

* 2. Email and/or phone number of nominee

Please explain constructive contributions nominee has made to the PA profession that display leadership, responsibility, and expertise.

Question Title

* 3. Please explain constructive contributions nominee has made to the PA profession that display leadership, responsibility, and expertise.

How has nominee actively participated in bringing about change in our health care system?

Question Title

* 4. How has nominee actively participated in bringing about change in our health care system?

Please list nominee's participation in professional and community activities locally, nationally and/or internationally.

Question Title

* 5. Please list nominee's participation in professional and community activities locally, nationally and/or internationally.

How has nominee demonstrated high professional standards and commitment?

Question Title

* 6. How has nominee demonstrated high professional standards and commitment?

Describe how nominee has supported or mentored colleagues in the nominee's area of expertise.

Question Title

* 7. Describe how nominee has supported or mentored colleagues in the nominee's area of expertise.

Share how nominee supports the UNM PA Program through contribution of time, talent and/or resources.

Question Title

* 8. Share how nominee supports the UNM PA Program through contribution of time, talent and/or resources.

Please share any additional information that should be considered with this nomination.

Question Title

* 9. Please share any additional information that should be considered with this nomination.

Please note the best way for us to contact you 

Question Title

* 10. Please note the best way for us to contact you 

T