This application must be completed in its entirety to be considered.  It is recommended to have all information in a word document that you can copy and paste into the form below.

Supporting documents can be emailed to ArkSHA@ArkSHA.org or attached below. 

Items to include:

1. Brief Statement of Nomination (3 sentences or less).
2. Photo of Nominee
3. REQUIRED: Narrative text that provides the rationale for why this individual is being nominated. Consider the following points for the narrative text:
   1. Identification and description of the outstanding clinical or research achievement.
   2. Information on when and where the specific achievement took place
   3. Description of the significance of the achievement
   4. Explanation of how the nominee's actions have advanced knowledge in the area of clinical, practical, or research.
   5. Explanation of the nominee's role in the achievement
4. OPTIONAL: Supporting letters of recommendation from individuals familiar with the nominees' works.