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Lane Adams Quality of Life Award Nomination Form


The American Cancer Society will be accepting nominations for the 2015 Lane Adams Quality of Life Award between April 15 and July 15, 2014. To submit a nomination fill out the online form below or you may download the Lane Adams 2015 nomination form by clicking here. Instructions for submitting the downloadable PDF version are included in the form.

The online form or the downloadable form is to be completed by the nominator and will be considered in the selection of the finalists for the Lane Adams Quality of Life Award. Once the Selection Committee has chosen the finalists, additional information may be needed.

Nominators are encouraged to review the four criteria outlined and illustrated under "Who is Eligible for the Lane Adams Quality of Life Award?” section of this website.
1) Is a professional health care provider that provides direct care, counsel, and/or service to cancer patients and their families.
2) Has a demonstrated record of outstanding performance that goes above and beyond the usual roles and responsibilities associated with his or her position.
3) Serves as a role model for colleagues.
4) Has used innovative and collaborative approaches to enhancing the quality of life for cancer patients and their families.

The nomination "statement" should give specific examples of these four characteristics of the nominee's work and accomplishments.

Should you have any question regarding the awards or nomination process, please contact Ann Robinson at 404-329-7720, or via email at ann.robinson@cancer.org.

 

Only complete nominations with the two required letters will be reviewed. All fields are required.


* Required Fields
1
NOMINEE INFORMATION
 
 
 
 
 
 
 
 
2
NOMINATOR INFORMATION
 
 
 
 
 
 
 
 
 
3
EXAMPLES OF LEADERSHIP, INNOVATION AND EXCELLENCE
Finalists will be selected on the basis of Leadership, Innovation and Excellence. Please include a statement in the box below, not to exceed 7500 characters, including spaces, which addresses the following question:
What sets the nominee apart from their colleagues with regard to cancer caregiving?
Share examples of how this person has exceeded the expectations of their job duties to demonstrate consistent excellence or innovative approaches in cancer care.
 
4
LETTERS OF SUPPORT REQUIRED
To complete this nomination process, please send (under separate cover) two letters of support for this nominee. Letters should offer insight and/or examples of ways in which nominee provides consistent, outstanding, compassionate care to cancer patients and their families.
One letter must be from a patient or family member, and one from a colleague/ co-worker. You may send two from each category if available. These letters are necessary for this nomination to go forward.

Fax, email, or mail letters to: (Be sure to include names of Nominator and Nominee)
American Cancer Society
ATTN: Ann Robinson
Office of the Chief Medical Officer
Department of Research and Cancer Control Science
250 Williams Street, NW
Suite 600
Atlanta, GA 30303-1002
Fax: 404-329-7530

THANK YOU