2024 NYACP Chapter Awards Nomination Form

Please complete all of the requested nominator and nominee information below, and upload:

  • Letter of Nomination (500 word maximum)
  • Nominee's CV

The Chapter Awards Committee will only consider candidate submissions that are received on or before June 15, 2024.

3-5 Chapter Awards are expected to be issued in 2024.

Self-Nominations will not be accepted.

Award Category - please check one *
Nominator's First Name *
Nominator's Last Name *
Nominator's Credentials *
Nominator's Email Address *
Nominator's Phone Number *
Nominator's Mailing Address *
Nominee's Name *
Nominee's Email *
Nominee's Phone Number *
Nominee's Mailing Address *
In what capacity has the nominee been engaged in ACP national or the New York Chapter? *
Has the nominee served on any ACP or NYACP Committee's? If so, provide committee name and length of service. *
Please provide any other activities (i.e. organization, hospital/institution, community, etc.) that are applicable and specifically support this nomination. *
Letter of Nomination *
Nominee's CV *

Fields marked with * are required.

Your form submission WILL be encrypted using SSL to ensure your privacy.

Contact Us

PO Box 38237 | Albany, NY 12203

Connect With Us

2024 New York Chapter of the American College of Physicians All Rights Reserved.