Award: California Optometrist of the Year 2019 - California Optometric Association
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Award: California Optometrist of the Year 2019

Submission Deadline: October 10, 2019

Nominating Society *
Nominee: *
Total number of years as a COA member: *
Total number of years in practice: *
Home address: *
Work address: *
Name of person submitting nomination: *
Phone number or email address of person submitting nomination: *
Describe the nominee’s public service outside of optometry to any or all of the following (30 points): country, state, or other political subdivision in any capacity; education; community; religious or service institutions; and charitable causes. *
(Maximum characters: 2000)
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Describe the nominee’s service to the visual welfare of the public in any or all of the following (20 points): sight-saving groups; legislative activities beneficial to the visual welfare of the public; participation in governmental health care programs; and participation in public service programs. *
(Maximum characters: 2000)
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Describe the nominee’s service to optometry (30 points): Contributions of personal time and effort on behalf of the profession’s advancement. *
(Maximum characters: 2000)
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Describe the nominee’s service to COA and affiliate organizations (20 points): service as an officer, committee chair or member, etc.; promotion of the association’s goals and programs; activity in support of association projects; and involvement in public information activities. *
(Maximum characters: 2000)
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Additional details about the nominee under 2,000 words, such as CV or biography: (optional)


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