Hippocrates Award Nomination Form | AMA (WA)

Hippocrates Award Nomination Form

  • About the Award

    This award is to honour those who have made a significant contribution to medicine.


  • Eligibility and Criteria

    It is expected that nominees will have demonstrated a tireless dedication to either the service of others, their chosen field, or be pioneers in the health and medical research sector. Nominations should be accompanied by adequate evidence of achievements or contributions to health, primarily in Western Australia and include the names of supporting referees.


  • Conditions of Entry

    • • Finalists must be a member of the AMA (WA).
    • • Nominations are to be submitted online through the ‘Submit a Nomination’ button below.
    • • All nomination information and material remains the property of the AMA (WA) Award Panel.
    • • All nomination information and material can be utilised by the AMA (WA) to publicly recognise the award recipient and award finalists.
    • • Information about the award finalists and winner may be published in the AMA (WA) monthly journal Medicus and/or Med e-link.
    • • The decision of the selection panel is final and no correspondence will be entered into. 6. Self-nomination is permissible.

    • Key Dates

    • • Friday 3 June 2022 Nominations close at 5:30 pm.
    • • Nominees will be notified if they are shortlisted as a finalist.
    • Saturday 23 July 2022 Winner announced at the AMA (WA) MEDCON22 Gala Ball.

    • COMPLETE THE NOMINATION FORM BELOW AND SUBMIT


    • Section A: Your Details

    • Section B: Nominee's Details

      Please provide details of the Doctor in Training you are nominating below.
    • Section C: Supporting Documentation

    • Section E: Declaration by Proposer