Distinguished Member Award Application

PACR Distinguished Member Award Nomination Form

About the Submitter

Submitter Name

Submitter Email

Submitter Phone

About the Nominee

Current PACR Member

Yes

Membership Type

Active

Associate

Student

Sustaining

Nominee Name

Street Address

Apt/Suite/Office

City

State

Zip

Nominee Email Address

Phone Number

In order for the person you have nominated to be considered for the PACR Distinguished Member Award, please provide a narrative summary of how the nominee meets the established criteria as outlined in Policy #4 "Distinguished Member Award Nomination and Criteria."

Criteria #1: State Association Activities: Nominee promotes Registry Profession on a State Level

To your knowledge, describe how the nominee has actively participated in any of the following state association capacities: Serving as an officer, committee chair and/or committee member.

Criteria #2: National Association Activities: Nominee promotes the Registry Profession on a National Level

To your knowledge, describe how the nominee has actively participated in any of the following national association capacities: Serving as an officer, committee chair, and/or committee member.

Criteria #3: Advancement of Cancer Registry Profession (General): Nominee promotes the advancement of the Registry Profession by adhering to at least two (2) or more of the following subcriteria.

To your knowledge, describe what year the nominee became a certified tumor registrar (CTR).

To your knowledge, describe how the nominee has disseminated his/her knowledge through consultation to others in the field by listing contributions through research and/or published materials. (example, NCRA, NAACCR, PACR articles, newsletters).

To your knowledge, describe how the nominee is a recognized resource person in the area of specialty through development of professional theory and/or techniques as evidenced through proof of being a primary presenter or co-presenter involved at local, state, regional or national workshops, meetings, seminars or conferences.

To your knowledge, describe other contributions to the profession and to society through religious, civic, or other community activities.

Resume or Curriculum Vitae

Upload a copy of the nominee's most current resume/CV.

Maximum file size: 268.44MB

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Members

Members Only Area

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