AWARD NOMINATION FORMS – PRIMARY NOMINATORS

Primary Nominators! Complete the appropriate award nomination form below.

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

BACK TO AWARDS INFORMATION

ADDITIONAL NOMINATOR FORMS

Leadership & Advocacy

Leadership and Advocacy Award - Primary Nominator

Nominee Information
Name*
First Last
OPA/CPA membership number*
Address*
Street Address Address Line 2 City Province Postal Code
Phone*
Email*
Would you prefer that OPA staff contact the nominee to request a copy of their current CV? Please note, if you select no, you are required to upload the CV in the space provided in this form. If you select yes, OPA staff will disclose the purpose of the request to the nominee and you will be informed when the CV has been received from the nominee.*
- Yes, I would like OPA staff to request the nominee's CV
- No, I will request the nominee's CV
Rationale
The following section should outline why this nominee is a good candidate for the OPA Leadership and Advocacy Award. Please give specific examples by answering the following questions. When possible, comments and/or quotes by various fellow OPA members, other healthcare providers and community members are encouraged. Using point form is acceptable and encouraged.
1. Please give specific examples of how the nominee has held leadership roles within the profession in the area(s) of clinical practice, research, education and/or professional association activities.*
2. Please provide an example of how the nominee is seen as an ambassador for physiotherapy, increasing the awareness and value of physiotherapy to the public and/or health care community.*
(e.g., publications, presentations)
3. Provide an example of how the nominee has exceptional integrity, professionalism, accountability and communication.*
4. Please provide any examples of how the nominee has been able to successfully advance the profession by engaging in advocacy initiatives that have positively influenced decision makers and other stakeholders at the local and/or provincial level.*
5. Please provide any examples of how the nominee is recognized as a mentor, inspiring others to grow in their own professional activities and contribute to the profession.*
6. Please add any additional comments regarding why you feel this nominee is deserving of this award – personal reflection, quotes from other people, citations in the media etc. are all encouraged.
Upload any accompanying documents
Max. file size: 150 MB.
Upload the nominee's CV
Max. file size: 150 MB.
Nominator Information
Please provide your name and email and names and email addresses for four additional nominators, three of whom must be OPA/CPA members in good standing. Please ensure all additional nominators complete the Additional Nominator form or the Non-member Nominator form respectively. Primary nominators are required to ensure that they share the responses to the questions answered above with all the additional nominators.
#1 Primary Nominator Name*
Enter your name and email (the one completing this form) in this section.
First Last
#1 Email*
OPA/CPA membership number*
Your Signature*
#2 Nominator Name*
First Last
#2 Email*
OPA/CPA membership number
#3 Nominator Name*
First Last
#3 Email*
OPA/CPA membership number
#4 Nominator Name*
First Last
#4 Email*
OPA/CPA membership number
#5 Nominator Name*
First Last
#5 Email*
OPA/CPA membership number
If non-member type "non-member"

Innovation & Advancement

Innovation and Advancement - Primary Nominator

Nominee Information
Name*
First Last
OPA/CPA membership number*
Address*
Street Address Address Line 2 City Province Postal Code
Phone*
Email*
Would you prefer that OPA staff contact the nominee to request a copy of their current CV? Please note, if you select no, you are required to upload the CV in the space provided in this form. If you select yes, OPA staff will disclose the purpose of the request to the nominee and you will be informed when the CV has been received from the nominee.*
- Yes, I would like OPA staff to request the nominee's CV
- No, I will request the nominee's CV
Rationale
The following section should outline why this nominee is a good candidate for the OPA Innovation and Advancement Award. Please give specific examples by answering the following questions. When possible, comments and/or quotes by various fellow OPA members, other healthcare providers and community members are encouraged. Using point form is acceptable and encouraged.
1. Please provide how the nominee has advanced the science of the profession by demonstrating innovation in clinical practice, research, technology and/or education.*
2. Please provide examples of how the nominee has shared their innovations with the broader physiotherapy community.*
(e.g. publications, presentations – please enclose copies where possible)
Upload any accompanying documents
Max. file size: 150 MB.
Upload the nominee's CV
Max. file size: 150 MB.
3. Please provide how the nominee is known for being a visionary, progressive and dynamic.*
4. Please provide how the nominee has provided mentorship and fostered new talent in their field of practice*
5. Please add any additional comments regarding why you feel this nominee is deserving of this award – personal reflection, quotes from other people, citations in the media etc. are all encouraged.
Nominator Information
Please provide names and email addresses for four additional nominators, three of whom must be OPA/CPA members in good standing. Please ensure all additional nominators complete the Additional Nominator form or the Non-member Nominator form respectively. Primary nominators are required to ensure that they share the responses to the questions answered above with all the additional nominators.
#1 Primary Nominator Name*
Enter your name and email (the one completing this form) in this section.
First Last
#1 Email*
OPA/CPA membership number*
Signature
#2 Nominator Name*
First Last
#2 Email*
OPA/CPA membership number
#3 Nominator Name*
First Last
#3 Email
OPA/CPA membership number
#4 Nominator Name*
First Last
#4 Email*
OPA/CPA membership number
#5 Nominator Name*
First Last
#5 Email*
OPA/CPA membership number (if non-member, type "non-member"}

Outstanding Volunteer

Outstanding Volunteer - Primary Nominator

Nominee Information
Name*
First Last
OPA/CPA membership number*
Address*
Street Address Address Line 2 City Province Postal Code
Phone*
Email*
Would you prefer that OPA staff contact the nominee to request a copy of their current CV? Please note, if you select no, you are required to upload the CV in the space provided in this form. If you select yes, OPA staff will disclose the purpose of the request to the nominee and you will be informed when the CV has been received from the nominee.*
- Yes, I would like OPA staff to request the nominee's CV
- No, I will request the nominee's CV
Rationale
The following section outlines why this nominee is a good candidate for the OPA Outstanding Volunteer Award. Please give specific examples by answering the following questions. When possible, comments and/or quotes by various fellow OPA members, other healthcare providers and community members are encouraged. Using point form is acceptable and encouraged.
1. Please provide examples of how the member has been a tireless contributor to the Association on district, provincial or national committees and/or contributed to the profession in other volunteer capacities.*
(e.g., as an abstract reviewer, presenter, poster judge, event volunteer, acting as a voting delegate)
2. Please provide examples of how the nominee has acted as an informal or formal leader within their local community.*
(e.g., participate in local community events, fairs, festivals)
3. Please provide examples of how the nominee’s positive professional spirit has inspired other PTs or PTAs to volunteer in some capacity for the profession.*
4. Please add any additional comments regarding why you feel this nominee is deserving of this award – personal reflection, quotes from other people, citations in the media etc. are all encouraged.
Upload any accompanying documents
Max. file size: 150 MB.
Upload the nominee's CV
Max. file size: 150 MB.
Nominator Information
Please provide names and email addresses for four additional nominators, three of whom must be OPA/CPA members in good standing. Please ensure all additional nominators complete the Additional Nominator form or the Non-member Nominator form respectively. Primary nominators are required to ensure that they share the responses to the questions answered above with all the additional nominators.
#1 Primary Nominator Name*
Enter your name and email (the one completing this form) in this section.
First Last
OPA/CPA membership number*
#1 Email*
Primary Nominator Signature
#2 Nominator Name*
First Last
OPA/CPA membership number
#2 Email*
#3 Nominator Name*
First Last
OPA/CPA membership number
#3 Email*
#4 Nominator Name*
First Last
OPA/CPA membership number
#4 Email*
#5 Nominator Name*
First Last
OPA/CPA membership number (if non-member, type "non-member")
#5 Email*

Student/New Grad Leadership

Student/New Grad Leadership - Primary Nominator

Nominee Information
Name*
First Last
OPA/CPA membership number*
Address*
Street Address Address Line 2 City Province Postal Code
Phone*
Email*
Would you prefer that OPA staff contact the nominee to request a copy of their current CV? Please note, if you select no, you are required to upload the CV in the space provided in this form. If you select yes, OPA staff will disclose the purpose of the request to the nominee and you will be informed when the CV has been received from the nominee.*
- Yes, I would like OPA staff to request the nominee's CV
- No, I will request the nominee's CV
Rationale
The following section should outline why this nominee is a good candidate for the Student/New Grad Leadership Award. Please give specific examples by answering the following questions. When possible, comments and/or quotations by various fellow OPA members, other healthcare providers and community members are encouraged. Using point form is acceptable and encouraged.
1. Please provide examples of how the nominee has demonstrated leadership within their university and/or PT program.*
2. Please provide examples of the nominee’s involvement The nominee has been involved with the Association at a local, provincial or national level .*
(e.g., involved in district activities/events/meetings, district student representative, promotes membership in the Association, attends conferences, acts as a voting delegate, sits on the national Student Assembly)
3. Please provide examples of how the nominee has promoted physiotherapy in the community (e.g. volunteering with local charities, providing education community groups)*
4. Please provide examples of how the nominee has been involved in association activities at the provincial or national level (e.g. participation in OPA focus groups, member recruitment, representing their district as a voting delegate, National Student Assembly, attending InterACTION and/or Congress)*
5. Provide examples of how this nominee demonstrates a commitment to lifelong learning (e.g. poster presentations at InterACTION/Congress, research activities, mentoring opportunities)*
6. Please add any additional comments regarding why you feel this nominee is deserving of this award – personal reflection, quotes from other people, citations in the media etc. are all encouraged.
Upload any accompanying documents
Drop files here or

Max. file size: 150 MB, Max. files: 5.
Upload the nominee's CV
Max. file size: 150 MB.
Nominator Information
Please provide your name and email, and names and email addresses for four additional nominators, three of whom must be OPA/CPA members in good standing. Please ensure all additional nominators complete the Additional Nominator form or the Non-member Nominator form respectively. Primary nominators are required to ensure that they share the responses to the questions answered above with all the additional nominators.
#1 Primary Nominator Name*
Enter your name and email (the one completing this form) in this section.
First Last
#1 OPA/CPA membership #
#1 Email*
Your Signature
#2 Nominator Name*
First Last
#2 OPA/CPA membership #
#2 Email*
#3 Nominator Name*
First Last
#3 OPA/CPA membership #
#3 Email*
#4 Nominator Name*
First Last
#4 OPA/CPA membership #
#4 Email*
#5 Nominator Name*
First Last
#5 OPA/CPA membership # (if non-member, type "non-member")
#5 Email*

PTA Leadership

PTA Leadership - Primary Nominator

Nominee Information
Name*
First Last
OPA/CPA membership number*
Address*
Street Address Address Line 2 City Province Postal Code
Phone*
Email*
Would you prefer that OPA staff contact the nominee to request a copy of their current CV? Please note, if you select no, you are required to upload the CV in the space provided in this form. If you select yes, OPA staff will disclose the purpose of the request to the nominee and you will be informed when the CV has been received from the nominee.*
- Yes, I would like OPA staff to request the nominee's CV
- No, I will request the nominee's CV
Rationale
The following section outlines why this nominee is a good candidate for the OPA PTA Leadership Award. Please give specific examples by answering the following questions. When possible, comments and/or quotes by fellow OPA members, other healthcare providers and community members are encouraged. Using point form is acceptable and encouraged.
1. Please provide examples of how the nominee has demonstrated a strong commitment to patient-focused care.*
2. Please provide examples of how the nominee demonstrates outstanding professionalism, collaboration and team work.*
3. Please provide examples of how the nominee is a mentor, inspiring the best in their colleagues. If applicable, please include quotes/examples from colleagues and/or students.*
4. Please provide an example of how the nominee has raised the profile of PTAs and/or the physiotherapy profession in the health care community through clinical practice, education and/or research or through volunteer work with the Association (CPA/OPA).*
5. Please add any additional comments regarding why you feel this nominee is deserving of this award – include any related unique or innovative work not described above. Personal reflection, quotes from other people, citations in the media etc. are all encouraged.
Upload any accompanying documents
Max. file size: 150 MB.
Upload the nominee's CV
Max. file size: 150 MB.
Nominator Information
Please provide your name and email, and names and email addresses for four additional nominators, three of whom must be OPA/CPA members in good standing. Please ensure all additional nominators complete the Additional Nominator form or the Non-member Nominator form respectively. Primary nominators are required to ensure that they share the responses to the questions answered above with all the additional nominators.
#1 Primary Nominator Name*
Enter your name and email (the one completing this form) in this section.
First Last
#1 OPA/CPA membership #*
#1 Email*
Your Signature*
#2 Nominator Name*
First Last
#2 OPA/CPA membership #
#2 Email*
#3 Nominator Name*
First Last
#3 OPA/CPA membership #
#3 Email*
#4 Nominator Name*
First Last
#4 OPA/CPA membership #
#4 Email*
#5 Nominator Name*
First Last
#5 OPA/CPA membership # (if non-member, type "non-member")
#5 Email*

AWARD NOMINATION FORMS – PRIMARY NOMINATORS

Primary Nominators! Complete the appropriate award nomination form below.

Leadership & Advocacy

Innovation & Advancement

Outstanding Volunteer

Student/New Grad Leadership

PTA Leadership

Leadership & Advocacy

Leadership and Advocacy Award - Primary Nominator

Nominee Information

Rationale

Nominator Information

Innovation & Advancement

Innovation and Advancement - Primary Nominator

Nominee Information

Rationale

Nominator Information

Outstanding Volunteer

Outstanding Volunteer - Primary Nominator

Nominee Information

Rationale

Nominator Information

Student/New Grad Leadership

Student/New Grad Leadership - Primary Nominator

Nominee Information

Rationale

Nominator Information

PTA Leadership

PTA Leadership - Primary Nominator

Nominee Information

Rationale

Nominator Information