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Nominations

2010 Abraham Horwitz Award for Excellence in Leadership in Inter-American Health Nomination Form

Before completing this nomination, please be sure that you have read and understand the award guidelines and procedures. Please ensure you complete all the required fields in your application. You will not be able to save and complete the form at a later time.

Instructions: Please fill in all the requested information on the nomination form and attach a letter of nomination (two pages) signed by the nominator, a letter of support (two pages) signed by an individual other than the nominator and preferably from a country other than that of the nominee, and curriculum vitae of the nominee. Additional and unsigned documents cannot be considered.

Entries that are incomplete at the close of nominations cannot be considered.

All items marked with an asterisk (*) must be completed.

Nominee Information

Name of the candidate *

Title *

Current position *

Institution *

Address *

City *

Country *

Telephone number *

E-mail address *

Nationality *

Specialty *

Academic Degrees

(Please list in reverse chronological order)
Degree, Name of University, Year of Graduation

Academic Degree 1 *

Academic Degree 2

Academic Degree 3

Academic Degree 4

Recent Professional Experience

(Please list in reverse chronological order)
Title, Organization, Years

Recent Professional Experience 1 *

Recent Professional Experience 2

Recent Professional Experience 3

Recent Professional Experience 4

Selected Publications

Author(s), Date, Title, Journal, Volume, Number

Selected Publications 1 *

Selected Publications 2

Selected Publications 3

Selected Publications 4

Selected Honors

Honor

Honors 1 *

Honors 2

Honors 3

Honors 4

Impact Statement

Describe why this nominee deserves to win the Abraham Horwitz Award. Provide a brief description of his or her specific accomplishments, highlighting cross-border impact in the region of the Americas, and if applicable, in the world (400 words).

Impact statement *

Nominator Information

Name of nominator *

Title *

Current position *

Institution *

Address *

City *

Country *

Telephone number *

E-mail address *

Institution's Web site *

Relationship of nominator to nominee *

How did you hear about the Awards for Excellence in Inter-American Public Health? *
Select PAHEF Web site Other Web site Announcement in a journal List serve E-mail from PAHEF E-mail from PAHO Colleague Other