SPAP Pediatric PA of the Year Nomination Form

Please type or print legibly and complete the following information:
Does the PA nominee have a primarily pediatric patient population (>70% patients under 18y)? *
How many years of experience in pediatrics does the nominee have? *

Please answer each category below in as much detail as possible. Scores for each nominee will be calculated according to the quantity of examples provided as well as the level of commitment documented. We will also be asking the nominee for their CV for further information.

 

 APPLICATIONS ARE DUE APRIL 16TH, 2021.

PLEASE ENSURE THAT THE NOMINATION FORM IS COMPLETED PRIOR TO SENDING.

  • Current SPAP Board of Directors members are ineligible for nomination.
  • Nominees and nominators are not required to be members of SPAP.
  • Once nominated, SPAP will request a current CV from nominees to complete the nomination process.
Thank you!
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