AMA Honors Nomination Form

AMA Honors Nomination Form
Nomination Categories
Select an award to start your nomination.
The Tech Innovator Award

Technology is reshaping how physicians practice, how patients receive care, and how public health systems function.

The Tech Innovator Award recognizes an individual whose innovation has advanced healthcare through transformative impact, real-world application, and a commitment to safety, trust, and transparency.
The Public Health Champion Award

Strong public health creates healthier communities.

The Public Health Champion Award recognizes an individual whose leadership has advanced public health through measurable improvement in health outcomes, a lasting influence on public health systems, institutions, or policy, and by building credibility across communities and stakeholders.
The Excellence in Communication Award

Public understanding of health and medicine relies on clear, accurate communication.

The Excellence in Communication Award recognizes an individual whose communication has advanced public understanding or perception of health and medicine through demonstrated influence, engagement, and commitment to accurate, responsible communication.
Nominator Information
Full name

First nameLast name
Title and organization

TitleOrganization
Email
example@example.com
Phone number

Area codePhone number
Relationship to nominee

Other
Relationship to nominee

Other
Relationship to nominee

Other
Do you have any financial, personal, or professional relationship with the nominee beyond what is described above?

Yes
Nominee Information
Full name

First nameLast name
Title and organization

TitleOrganization
Title and affiliation

TitleAffiliation
Email
example@example.com
Primary location of work

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary platforms or formats

Other
Primary geography of work
Professional website or LinkedIn (optional)
Primary media profile or website (required)
Nomination Questions
Describe the nominee's innovation and explain how it represents a transformative advancement in healthcare. What measurable impact has it had beyond pilot settings?
How has this innovation been applied in patient care or physician workflows? Describe its adoption and the outcomes or improvements it has enabled.
How has the nominee demonstrated a commitment to developing and deploying this innovation responsibly? Please describe efforts related to safety, trust, or transparency.
Is there any additional information the Selection Committee should consider when evaluating this nomination? (optional)
Nomination Questions
Describe the nominee's most significant contribution to improving population health. What did they do, who did it impact, and what measurable outcomes or improvements resulted?
How has the nominee created lasting change in public health systems, institutions, or policy? Describe the enduring impact of their work.
How has the nominee built credibility and trust across communities and stakeholders? Please provide examples of how they have engaged diverse audiences or strengthened confidence in public health.
Is there any additional information the Selection Committee should consider when evaluating this nomination? (optional)
Nomination Questions
Describe the nominee's most significant contribution to improving public understanding of health and medicine. How has their communication influenced public awareness, engagement, or perception?
How has the nominee demonstrated a commitment to accurate, responsible communication? Please provide examples of how they have built and maintained credibility.
Describe the nominee's ability to engage broad audiences. Who has their communication reached, and how has it extended the impact of their work?
Is there any additional information the Selection Committee should consider when evaluating this nomination? (optional)
Supporting Materials
Nominee professional biography or CV

Please upload a professional biography or CV for your nominee, including their current role, relevant credentials, and career highlights. PDF, doc, or docx files only.
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Letter of support

Please upload one letter of support from someone other than the nominator. This letter should be from a peer, collaborator, or someone who has witnessed the nominee's contributions firsthand. The letter should speak specifically to why this person merits national recognition. PDF, doc, or docx files only.
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Supporting Links
Please provide up to three links to published work, research, media coverage, or other evidence of the nominee's impact. At least one link is required.
Link 1 (required)
Link 2 (optional)
Link 3 (optional)
Supporting Links
Please provide up to three links to representative work — articles, broadcasts, videos, posts, or other content. At least two links are required for this award, as the committee will want to evaluate the nominee's work directly.
Link 1 (required)
Link 2 (required)
Link 3 (optional)
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AMA Honors Nomination Form

Nomination Categories

The Tech Innovator Award

The Public Health Champion Award

The Excellence in Communication Award

Nominator Information

Nominee Information

Nomination Questions

Nomination Questions

Nomination Questions

Supporting Materials

Supporting Links

Supporting Links