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2022 APTA Innovation Award Form

Nominee/Nominator Information

Please Note: At any time after this first page, you may save your progress and leave the form by clicking "Save and continue later" at the bottom of the page on the right. You will be prompted to enter your email address, and the survey tool will email you a link where you can continue filling out the form at a later time. The email will come from Alchemer. Please check your spam/junk folder, if you don't see it in your inbox.

It's important that all sections of this application are completed.
1. Please provide the following information about the organization you are nominating: *This question is required.
2. Please provide the following information about yourself: *This question is required.