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2025 Innovators & Influencers Honorees Nomination Form

We want to feature the successes of our members! Please nominate yourself or someone who you believe has done something innovative and influential within the realm of PM&R. Honorees must be AAPM&R members in in their PGY3 through 15 years out of residency.

Examples can include but not limited to specialty or patient advocacy, volunteer organization leadership, national education, etc.

1. Are you nominating yourself or someone else? *This question is required.

Nominator's Information *This question is required.

Full Name with credentials
Email
City
State

2. Nominee's Information *This question is required.

Full Name with credentials
Current Practice
City
State
Residency Graduation Year
Email

3. What category does their influence fall into? *This question is required.

4. Nomination Statement: What have you/they done that is innovative and/or influential? *This question is required. (up to 350 words)

5. Impact Statement: Please use this space to provide information on the scope of impact (local, regional, national, international) and the impact on:

the specialty of PM&R including alignment with the vision for the specialty
and/or the PM&R patient population

*This question is required. (up to 350 words)

6. If available, please provide some relevant links or documents to show any coverage of the accomplishment i.e., press release, local coverage, etc. *This question is required.

LinksOptional. Please note, not all links need to be filled.

Link 1
Link 2
Link 3
Link 4
Link 5

Document Upload 1Optional

File: {{filename}} delete

Document Upload 2Optional

File: {{filename}} delete

7. If available, please provide references for endorsement.