Impact Awards 2022 Nomination Form

Impact Awards 2022 Nomination Form

Please fill out the application form below to nominate yourself or someone else for an NACDD Impact Award!

The application form should take only 15 minutes to complete. Be sure to have all of the materials you need for the application ready before you begin the form as you will not be able to save your progress and return to it later.

A successful application will have: Contact information for the nominee(s) and nominator; a letter of rationale detailing the reasons why the nominee is nominated; the nominee(s) resume(s). You also may wish to provide supplementary materials to further elaborate on your nominee's accomplishments.

The Awards are open to all NACDD Members listed in our Member roster. To be an NACDD Member, you must be a public health professional working in chronic disease prevention and control. More information on NACDD Membership is available at chronicdisease.org/page/ForMembers.

1) Some awards will have more than one awardee (please read the instructions for applying carefully)

2) Form letters are discouraged.

3) State/Tribal/Territorial Chronic Disease Departments are encouraged to submit nominations as a unit and with the approval of the Chronic Disease Director.

The application process closes at 11:59 p.m. ET on July 25. Award winners will be notified in August.

Questions? Email publications@chronicdisease.org for more information about this form or the Impact Awards process.

Name of Submitter

Who is submitting this application?

Submitter Contact

Please provide your email and phone number.

Name of Nominee

Who is nominated for this award? (Please list multiple names if the award includes a department or group of people.)

Nominee Title

What is the nominee's professional title? (For an award involving multiple people, please list each person's contact information.)

Nominee Organization

Who does the nominee work for (department, division, organization)?

Nominee Mailing Address

Please provide the full mailing address for the nominee. (For an award involving multiple people, please list each person's contact information.)

Nominee Contact Information

What is the nominee's phone number and email address? (For an award involving multiple people, please list each person's contact information.)

Award

Please select the award for your nominee. Keep in mind that a candidate cannot be nominated for more than one award per year.

Select

Is the nominee aware of the Award nomination?*

Is the nominee aware of this nomination? If the nomination is a surprise, note that we will not be contacting nominees unless they have been selected to receive the award.

Yes

File Attachments*

Please provide your application in one PDF document, no larger than 30 MB in size, which will include the following: 1. A letter of rationale detailing why the nominee is being nominated, the problem or challenge the nominee faced, and the accomplishments of the nominee. 2. The resume(s) of the nominee, including previous awards received and any relevant publications history. 3. Links to videos, images, or other supplementary materials that can help further elaborate on the nominee's accomplishments.

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