Online Award Submission Form

Awards & Grants

Online Award Submission Form

REMEMBER

Follow all specific submission guidelines for each award.
You cannot save and return to this form. Have all necessary supporting items ready before starting.
Only one nomination may be submitted at a time.
Current board members and selection committee members are not eligible and cannot be nominated.
For section grants, visit http://www.cps.ca/English/Awards&Grants/index.htm.
All field marked with * are mandatory.

SECTION 1 - AWARD SELECTION

* Award Selection:

SECTION 2 - CANDIDATE

Salutation:
* First Name:
* Last Name:
Title or occupation:
Company:
Department:
* Address:
* City:
* Province:
* Postal Code:
* Tel:	ext.
Fax:
* E-mail:

SECTION 3 - NOMINATOR (must be a CPS member)

CPS member:	Yes No
Salutation:
* First Name:
* Last Name:
Title or occupation:
Company:
Department:
* Address:
* City:
* Province:
* Postal Code:
* Tel:	ext.
Fax:
* E-mail:

SECTION 4 - SECONDER (Required for Ross, Career Research, Distinguished Neonatologist, Michel Weber, Life and Honourary awards only)

CPS member:	Yes No
Salutation:
First Name:
Last Name:
Address:
City:
Province:
Postal Code:
Tel:	ext.
Fax:
E-mail:

SECTION 5 - SUPPORTING DOCUMENTATION

Check individual award guidelines for specific requirements. To attach supporting documents, click on the “Browse” button, find and select your file in your directory and click “OK”. The file name will appear in the text box. (MS Word or PDF only)
Supporting document 1
Supporting document 2
Supporting document 3
Supporting document 4