Award Nomination Form

Review this nomination form and return when you have all required content to submit the form.

In the meantime, please email Keir Johnson, Awards Coordinator, to indicate your plans to submit a nomination and the name of the nominee.

Note: items with an asterisk (*) are required.

Learn more about the award categories here, including information about this year’s theme: improving access to care.

Nomination Form

Consideration Under Other Awards

The Awards Committee will consider nominations for the primary award selected above, as well as for other award categories. However, if you prefer this nominee to only be considered under the category you’ve indicated above, check off the box below.

Please only consider this nominee for the award selected above, and not under any other category.

Your Information

Nominator's Name *

Nominator's Email *

Nominator's Phone Number *

Nominee's Information

Candidate's Name *

Candidates Email *

Candidate's Phone Number *

Description *

Provide a brief description about why this candidate should be selected for this award, emphasizing alignment with this year’s theme where possible. This is the “elevator pitch” that summarizes the candidate’s achievements and qualities. (Please limit to a maximum of 500 characters).

Supporting Documentation

Upload the following documentation (*indicates required documentation). If there are challenges, you can email Keir Johnson at kjohnson@doctorsmanitoba.ca.

Required supporting documents for all award categories:

Curriculum Vitae
Reference letters or testimonials from at least two individuals, including one non-physician

Additional supporting documents that are encouraged but optional:

List of academic or professional honours/awards
List of publications and presentations
List of supporting awards and achievements (professional and personal)
Supporting press coverage
Any evidence to support improving access and continuity of care

Upload here *

Upload any letters of reference or testimony from at least 2 individuals, including at least 1 non-physician. One of the individuals can include the nominator.* Attach documentation here. To upload multiple files, please hold CTRL (Windows) or CMD (Apple).

References

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 13, 2026.

After clicking submit, you should see a confirmation screen and receive an email confirming receipt of your nomination.

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Award Nomination Form

Nomination Form

Your Information

Nominee's Information

References