Improving health in the Americas through health promotion, education, and training
Donate online
Browse the PAHEF e-Store
See PAHEF's Impact
2011 Clarence H. Moore Award

The 2011 Clarence H. Moore Award for Excellence for Voluntary Service Nomination Form

Before completing this nomination form, please be sure that you have read and understand the award guidelines. Please ensure you complete all the required fields in your application.

Instructions: Please fill in all the requested information on the nomination form and attach a letter of nomination (two-page limit) signed by the nominator, letter of support (two-page limit), and the annual report. Unfortunately, we are unable to consider unsigned documents.

To be considered, please ensure that you have completed and submitted the online nomination on or before the closing date of the call.

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

Note: You must click the “Save” button at the bottom of each page to save your responses.

If you have questions about completing this form, contact
  STEP 3 of 4  
  Nominator Information
  Name of nominator *
  Title *
  Current position *
  Institution *
  Address *
  City *
  State or province *
  Country *
  Telephone number *
  E-mail address *
Relationship of nominator to nominee *
  How did you hear about the Awards for
Excellence in Inter-American Public Health? *
  PAHEF website Colleague  
  Other website
  Announcement in a journal  
  List serve  
  E-mail from PAHEF  
  E-mail from PAHO