Download Annual VTAAC Impact Award – 2017

Annual VTAAC Impact Award – 2017
2017 Award Nomination Form:
The VTAAC Impact Award is to recognize excellence in reducing Vermont’s cancer burden. Awards will
honor those who have made extraordinary contributions to addressing cancer prevention, detection,
treatment and/or survivorship. Two awards will be presented, to support the efforts of individuals supporting
(a) VTAAC-related activities and (b) Activities external to VTAAC.
The nomination deadline is Friday, March 24, 2017.
Nominations may be submitted by anyone having firsthand knowledge of the nominee’s contribution to
cancer prevention and control in Vermont. Selection of the winner will be made by the VTAAC Executive
Committee on the basis of the leadership and extraordinary achievements of the nominee. The 2017
winners will be notified via email and awards will be presented at the VTAAC Annual Meeting on April 12,
2017.
Nominee
Name:
Organization:
Phone/email:
Nomination type
(select one):
Nomination Date:
Nominator
Name:
Organization:
Phone/email:
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☐ VTAAC-Related Activities
☐ Unknown/Unsure
☐ Activities External to VTAAC
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Nomination Justification
Please tell us why you are nominating this person. Share highlights of the nominee’s accomplishments
which focus on cancer prevention and control. Please limit your response to 400 words or less.
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Please email completed forms to: Jessica French at [email protected]
Or Mail to: Jessica French, 55 Day Lane, Williston, VT 05495
Nomination Deadline, Friday, March 24, 2017