Error Messages

The survey closed on Friday September 23, 2022

2022 Humanitarian of the Year

Physician Assistant Nominee Information

Please enter the name of your nominee

Address 1

Address 2

City, State, Zip

Phone number

Email address

Please explain why you are nominating this PA

Service, Leadership and Community Involvement

Please list any awards or honors received

How has the nominee demonstrated exemplary service and leadership, and been a mentor to others? Please cite examples.

Please list any educational, community or extracurricular service activities participated in by the PA.

How has the nominee made significant contributions to improving access and quality of healthcare to underserved patient populations? Please cite examples

Your Information

Your Name

Your Email

---