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Copic Humanitarian Award Nomination Form

The Copic Humanitarian Award is presented each year to honor a physician for volunteer medical services and contributions to their community. We specifically look to recognize physicians who unassumingly volunteer outside the spectrum of their day-to-day lives. Please note: nominees must be a member of their state medical association in all states listed below except Nebraska.

Nomination Description

To help ensure that all candidates can be given equal consideration, we strongly recommend that you answer the following questions as they relate to the nominee’s contributions to his or her health care community. Please limit narrative to no more than two pages. You will strengthen your nomination by following these instructions.

  1. List and describe nominee’s specific volunteer activities (where, what, when, how often, etc.)
  2. How do the nominee’s volunteer activities specifically impact his/her community?
  3.  Why do you feel this individual deserves to be recognized?

SUBMISSION OF NOMINATION FORM

Simply fill out the information above, attach your narrative form, and hit the Submit button.

We may contact you for additional information if necessary. You will receive confirmation once your nomination form has been received.
Questions? Contact Laura Wadleigh at 720.858.6077 or [email protected].

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