NOMINATION FORM: 2027 Bernard Lown Award for Social Responsibility Survey

To honor Dr. Lown’s memory, and because our society needs more leaders like him, we created the Bernard Lown Award for Social Responsibility. The BLASR is given each year to a young clinician who demonstrates bold leadership in social justice, health care reform, environmental justice, global peace, or other humanitarian efforts, and comes with a $25,000 prize.

To be eligible, candidates must:

-be aged 45 or younger
-be a clinician in the United States
-stand out for their bold leadership in social justice, health care reform, environmental justice, global peace, or other humanitarian efforts

Self nominations are accepted. Nominations will be accepted through January 18, 2027.

For more information, visit the award website or contact us at LownAward@LownInstitute.org

1.Nominator Information(Required.)

Your name*

Your email address*

Your phone number

Relationship to nominee (if any)

Your job title

Your organization

2.Nominee information(Required.)

Nominee's name*

Nominee's email

Nominee's phone number

Nominee's LinkedIn

Nominee's job title

Nominee's organization*

3.Eligibility (must select all three to be eligible)

Is your nominee a clinician working in the United States?

Will your nominee be 45 years old or younger on June 7, 2027?

Has your nominee taken on professional or personal risk to do their work?

4.Tell us why you are nominating your candidate for the Bernard Lown Award. To be eligible, the candidate needs to have demonstrated bold leadership in social justice, health care reform, environmental justice, global peace, or other humanitarian efforts.

Describe a specific activity/accomplishment undertaken by the candidate that supports their nomination. (250 words maximum)(Required.)

5.Describe a specific additional activity/accomplishment undertaken by the candidate that supports their nomination. (optional - 250 words maximum)

6.Describe a specific additional activity/accomplishment undertaken by the candidate that supports their nomination. (optional - 250 words maximum)

7.Bold leadership in advancing social responsibility often requires taking personal and professional risk. Previous winners have risked their career bringing evidence of a city's tainted drinking water to public attention or taken a position at the front lines of securing health justice for immigrants. Describe how this applies to your nominee. (100 words maximum)(Required.)

8.Upload a CV, resume, or list of achievements. (optional but highly encouraged)

No file chosen

9.Upload a newspaper article or other published piece about your nominee. (optional)

No file chosen

10.Upload a piece written by your nominee or a similar document sharing your nominee's abilities. (optional)

No file chosen

11.Is there anything else you'd like us to know about your nominee?