AWARD NOMINATION FORMS – ADDITIONAL NOMINATORS

Submit all your nominations by Sunday, October 29, 2023. Contact us with any questions.

Nominee Information
Name*
First Last
Award Nomination is for:*
- Leadership and Advocacy
- Innovation and Advancement
- Outstanding Volunteer
- PTA Leadership
- Student/New Grad Leadership
Nominator Information
Please complete the information below. By so doing you are supporting the nomination of the nominee named above for an Ontario Physiotherapy Association Award.
Name*
First Last
Email*
OPA/CPA membership number
Upload any letters or additional documents supporting the nomination
Max. file size: 150 MB.
Date*
DD slash MM slash YYYY
Signature*

Nominee Information
Name*
First Last
Award Nomination is for:*
- Leadership and Advocacy
- Innovation and Advancement
- Outstanding Volunteer
- PTA Leadership
- Student/New Grad Leadership
Nominator Information
Please complete the information below. By so doing you are supporting the nomination of the nominee named above for an Ontario Physiotherapy Association Award.
Your Name*
First Last
Your Email*
Date*
DD slash MM slash YYYY
Please provide a brief explanation (1 page maximum) outlining your affiliation to the nominee and your rationale for supporting the nomination.*
Drop files here or

Max. file size: 150 MB.
Your Signature*

Nominee Information