Lane Adams Quality of Life Award Nomination Form
This 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) Excellence in direct caregiving
2) Demonstrated record of performance that exceeds the expectations for a person in that role or job
3) Role Model for colleagues
4) Demonstrated record of innovation / collaboration in enhancing 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.
Completed applications must be received no later than November 1, 2011. You may submit an application online or mail a printed nomination form [Word, 34KB]. If you choose to send your application form via hard copy, please mail it to:
American Cancer Society
ATTN: Ann Robinson
Office of the Chief Medical Officer
Department of Research and Cancer Control Science
250 Williams Street, NW
Atlanta, GA 30303-1002
Should you have any question regarding the awards or nomination process, please contact Ann Robinson at 404-329-7720, or via email at firstname.lastname@example.org.
Only complete nominations with the two required letters will be reviewed. All fields are required.