FCIHR Award of Honour
Nomination Form
FCIHR AWARD OF HONOUR
Presented to the individual or organization whose work has made a notable contribution
to health research in Canada
The Board of FCIHR shall, from time to time, recognize individuals in the lay community,
organizations, or corporations who have contributed significantly to CIHR and its mandate.
Nominations for this award may emanate from members of FCIHR, from volunteer Health
Agencies, from CIHR Institute Scientific Directors, from Chairs of Institute Advisory
Boards, and from Health Researchers. The award will be in the form of a scroll suitable for
framing. The award will be presented at appropriate ceremonial dinners, FCIHR Annual
Meetings, Scientific award Ceremonies, or annual meetings of Research Societies.
Nominations will be evaluated by an awards committee of the Board of Directors.
| Nominator | ___________________________ | Nominee | _______________________________ |
| Organization | ___________________________ | Organization | _______________________________ |
| Address | ___________________________ | Address | _______________________________ |
| ___________________________ | _______________________________ | ||
| City | ___________________________ | City | _______________________________ |
| Province | ___________________________ | Province | _______________________________ |
| Postal Code | ___________________________ | Postal Code | _______________________________ |
| Phone | ___________________________ | Phone | _______________________________ |
| Fax | ___________________________ | Fax | _______________________________ |
Reason for Nomination: (please use additional pages)
Please submit this form and the Nominee’s résumé to:
Awards Committee, Friends of CIHR
GG441 Health Sciences Centre, 820 Sherbrook Street, Winnipeg, MB R3A 1R9
tel: (204) 787-3794 fax: (204) 787-3279
e-mail: fcihr@fcihr.ca