2021 Filerman Prize Nomination Form

The Filerman Selection Committee, appointed by the Chair of the AUPHA Board of Directors, will evaluate the nominations.

Please complete and submit the following form no later than March 1, 2021 for consideration. Please contact Chris Anne Sanyer, Director of Membership, if you have any questions.

1. Nominator Contact Information *This question is required.

Space Cell	Response
Name	Name: Response
University/Organization	University/Organization: Response
Email address	Email address: Response
Phone Number	Phone Number: Response

2. Nominee Contact Information *This question is required.

Space Cell	Response
Name	Name: Response
University	University: Response
Email address	Email address: Response
Phone Number	Phone Number: Response

3. Upload Nominee's Curriculum Vitae *This question is required.

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4. Upload Nominee's Biosketch *This question is required.

File: {{filename}} delete

5. Upload Nomination Letter #1 *This question is required.

File: {{filename}} delete

6. Upload Nomination Letter #2 *This question is required.

File: {{filename}} delete

7. Upload high resolution head shot of Nominee *This question is required.

File: {{filename}} delete