EmailMeForm
Full Name of Nominee
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Credentials
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PA-C, DMSc, DFAAPA, etc.
Current Employer
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Position/Title
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Work Address
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Street Address
City
State / Province / Region
Postal / Zip Code
Phone Number
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Email Address
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Years of Experience as a PA
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Full Name of Nominator
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Relationship to Nominee
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Phone Number
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Email Address
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Please attach a detailed letter explaining why the nominee deserves the PA of the Year award. The letter should address the nominee's qualifications in relation to KAPA's mission, vision, and values, and provide specific examples of the nominee's contributions to the PA profession, patient care, and the community.
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Limited to one file, Allowed file types: Microsoft Word or PDF.
Yes
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By clicking YES above, the nominator affirms that the information provided in this nomination is accurate and that the nominee meets all eligibility criteria for the KAPA PA of the Year award.