MSA Awards Nominee Form Order Number Your Name * Your Email Address * Name of Nominee: * Nominee's Email Address * Nominee's Site of Employment: * BCWH BCCH Other Category of Nomination (may be more than one): * Patient Champion QSVI Champion Rookie of the Year Mentor/Educator of the Year Leadership Recognition Award Research Recognition Award Global Health Award Indigenous Health and Outreach Advocate President’s Award Why should the nominee receive this award? How has the nominee impacted this area? List any notable accomplishments or examples or how they are deserving of this award. *