Nominations Form for Health Sciences Alumni Awards

Notes for Nominators:

All letters of support are confidential and will be viewed only by members of the Selection Committee.
It is recommended that the nomination remain confidential and not shared with the nominee.
Posthumous nominations will not be accepted.
Bullet points are preferred.
We look forward to receiving your nomination.
Please submit the full nominations package by June 15, 2026
Direct any questions about the awards to fhsalumni@uwo.ca

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Name of Nominee*

Degree and Year of Graduation

(if known)

Address*

City*

Country*

Postal Code*

Email*

Current Telephone Number*

Name*

Address*

City*

Country*

Postal Code*

Email*

Current Telephone Number*

Relationship to Nominee*

1. How has this candidate made an impact through their professional achievement?

2. How has this candidate advanced their community through research and/or education?

3. How has this candidate displayed leadership and commitment to community service?

4. How has the candidate demonstrated that they align with the awards criteria?

5. Describe the candidate's accomplishments, impacts, and successes as they relate to the awards criteria.

6. Please include any other information about the candidate that might assist the Selection Committee.

7. Please attach letters of support

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Max. file size: 10 MB, Max. files: 2.

8. Optional - Please attach a current C.V. if available.

Max. file size: 10 MB.

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