The C2 Awards 2020 Nomination

Nomination Form

Nomination Due Date: 5:00PM Eastern time on Friday, November 15, 2019.

To make a nomination for the Cancer Community (C2) Awards, please complete the following form. We anticipate this should take no more than 10 minutes to complete. Details for award criteria can be found on the C2 Awards page and general rules for nominations are as follows:

Nominations must be received by 5:00PM Eastern time on Friday, November 15, 2019.
Nominees must be based in the United States.
Nominators may nominate themselves, their own organization or another person or organization.
Nominators may nominate up to five (5) individuals or organizations per category. Each nomination will require its own form.
Employees and family members of AstraZeneca and/or Scientific American Custom Media are not eligible to be nominated
For more information on the Rules & Regulations, please see here.

We appreciate your contribution to these awards. For a detailed description of the 2019–2020 Award Categories, please see C2 Awards.

*Please note that fields marked with an asterisk are required and a nomination cannot be submitted if these are left blank.

Nominator Information

Name:*

Title / Affiliation:*

Email Address:*

Phone Number:*

Your Relationship To The Nominee:*

Please specify if you are nominating an individual or organization:
IndividualOrganization

Nominee Information

Pick this nominee's award category* (only select one):

The C2 Catalyst For Change AwardThe C2 Catalyst For Care AwardThe C2 Catalyst For Precision Medicine AwardThe C2 President's Award

Nominee Name (Individual or Organization):*

Nominee Title / Affiliation (For Individuals only):

Nominee Postal Address:

Nominee Email Address:*

Nominee Phone Number:

Nominee Bio:
Please paste below a brief bio of the individual or organization that you are nominating.
Word Left: 75(Optional; Maximum 75 Words)

Please describe this nominee's work, as it relates to this award category, keeping in mind the criteria for this specific Award category. For a detailed description of the 2019–2020 Award Categories, please see C2 Awards.*
Word Left: 75(Required; Maximum 75 Words)

At the local, regional or national level, how did this nominee's work impact or change the community?*
Word Left: 75(Required; Maximum 75 Words)

Please provide an overview of quantitative measurements of success from the nominee's work. For example, the number of cancer patients or families touched, lives saved, treatments performed, or meals served.*
Word Left: 75(Required; Maximum 75 Words)

Is there anything else about this nominee that you would like the judges to consider?
Word Left: 75(Optional; Maximum 75 Words)

If necessary, you can include up to two supplemental pieces of information (e.g., an article or video) for this nomination. Note that the judges reserve the right to ask for additional information.
Article:
(Optional; PDF only [5MB maximum])
OR
Video URL:
(Recommend: Vimeo, YouTube, Google Drive, Dropbox.)