Stroke Stars Nomination Form – Stroke Care Network

Please provide as much information as possible for consideration.
Nominee Name
Nominee Credentials
Nominee Organization
Nominee Current Position
Reason for nomination
Nominee Honors and Awards (optional)
List of additional significant contributions for example: presentations, publications, committee memberships and offices held within any scientific organizations
Name of person making nomination*
Email of person making nomination*
Nomination Disclaimer: Submitting a nomination form does not guarantee selection of the nominee in the Stroke Stars Recognition program. Please be aware, if your nominee is not selected for the award in the month submitted the nomination will be carried over for future consideration.