Stovall Award Nomination Form - NCCS - National Coalition for Cancer Survivorship

Ellen L. Stovall Award Nomination Form

Please complete the following form to submit a nomination for the Ellen L. Stovall Award for Innovation in Patient-Centered Cancer Care.

If you have any questions, or encounter any difficulty with submitting a nomination, please contact Nadine Dorvelus at ndorvelus@canceradvocacy.org.

SUBMISSION DEADLINE: JANUARY 15, 2025 11:59 PM PACIFIC.

"*" indicates required fields

Is this submission a self-nomination?*

Note: If you are nominating an organization that you are affiliated with, choose "Yes."

Yes

Nominator Information

Name*

First Last Credentials (if applicable)

Organizational Affiliation (if applicable)

Email*

Enter Email Confirm Email

Phone*

Nominee Information

Nominee is best described as:*

Advocate or Advocacy Organization

Health Care Professional or Practice

Nominee*

Organizational Affiliation (if applicable)

Contact Name*

First Last Credentials (if applicable)

Contact Email*

Enter Email Confirm Email

Contact Phone*

Note: The Selection Committee may choose to contact the nominee for additional information.

Narrative

Upload a narrative letter of support explaining why the nominee should be considered for the Ellen L. Stovall Award.

In the letter, please include the writer's name and relationship to the nominee, and describe how the nominee meets each of the three award criteria below:

To see nominee criteria, please make a selection in the form field labeled "Nominee is best described as" in the section above.

Promoting the principles of patient-centeredness, especially emphasizing access to care, respect for patient preferences, and coordination and integration of care.
Engaging patients, families, and caregivers to inform the process of improving the delivery of quality cancer care.
Collaborating effectively with other advocates and/or advocacy organizations to align efforts to improve quality within the cancer care system.

Honoring the principles of patient-centeredness, especially emphasizing access to care, respect for patient preferences, and coordination and integration of care.
Engaging patients, families, and caregivers in the design of quality cancer care systems.
Collaborating with others in the cancer care system for ongoing quality improvement efforts.

Upload Narrative Letter of Support*

Accepted file types: docx, pdf, odt, doc, Max. file size: 12 MB.

Word, PDF, or OpenOffice file formats accepted.

Note: Nominations and letters will not be shared, without permission of the nominee, with anyone besides NCCS staff and Stovall Award Selection Committee members.

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