Award: California Young Optometrist of the Year 2018 - California Optometric Association
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Award: California Young Optometrist of the Year 2018

Submission Deadline: October 10, 2018

Nominating Society: *
Nominee: *
Total number of years in practice: *
Home address: *
Work address: *
College(s), degree(s), date(s) *
Employed by:
Partner of:
Name of person submitting nomination: *
Phone number or email address of person submitting nomination: *

Important Information

  • Nominees must be COA members and have practiced more than one (1), but not more than ten (10) years.
  • As many as five awards may be given
  • Nominations must come from affiliate societies of COA.
  • Nominations will be judged by a committee of past presidents of COA.
  • Candidates will be judged on activities completed since their licensure as an optometrist.

 

Contributions to local society, state and national associations (45 points)

List local society office(s) and committee chairmanship(s) held (including dates). *
(Maximum characters: 2000)
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List COA office(s), committee chairmanship(s) or membership(s) held (including dates) *
(Maximum characters: 2000)
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List AOA office(s), committee chairmanship(s) or membership(s) held (including dates) *
(Maximum characters: 2000)
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List other optometric professional affiliations and office(s) held (include dates) *
(Maximum characters: 2000)
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List academic and professional awards and honors received since licensure as an optometrist, including the name of the school or organization conferring the honor (include dates) *
(Maximum characters: 2000)
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Contributions to the community (45 points)

List professional public service activities (i.e., school screenings, free consultations, etc.) *
(Maximum characters: 2000)
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List appointive and/or elective local, state, and federal governmental offices held (include dates) *
(Maximum characters: 2000)
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List community organization activities, offices held or honors received (include dates) *
(Maximum characters: 2000)
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List community public speaking engagements given (include number and topic) *
(Maximum characters: 2000)
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Research or knowledge shared through published papers and articles (10 points)

List optometric books and/or articles authored since licensure as an optometrist *
(Maximum characters: 2000)
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List subjects of research projects conducted since licensure as an optometrist *
(Maximum characters: 2000)
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List topics of education lectures presented to optometrists since licensure as an optometrist *
(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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