Nomination Form

Please select the Award that you are submitting a nomination for.
  • Distinguished Service
  • Physician of the Year
  • Medal of Excellence
  • Resident of the Year
  • Dr. Jack Armstrong Humanitarian Award

Upload the following documentation (*indicates required documentation):

  • Curriculum Vitae*
  • List of academic or professional honours/​awards*
  • Personal testimony from at least 2 individuals (min. of 1 non-physician testimony)*
  • List of publications and presentations
  • List of supporting awards and achievements (professional and personal)
  • Supporting press coverage
Attach documentation here.

Additional Information

Please include information for up to three references or contacts (Name, email, phone for each)

Name Email Phone

The deadline to receive nominations is December 152021