Junior Doctor of the Year Award Nomination Form | AMA (WA)

Junior Doctor of the Year Award Nomination Form

  • 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

  • (a) Statement addressing criteria

    • • Provide a short statement of who is to be nominated and why?
    • • Provide a statement as to how the nominee has provided outstanding service/performance within the Medical Profession and the Community. The demonstration can be in one or more of the following areas:
      • • Teaching and Education
      • • Leadership and Advocacy
      • • Doctors' Wellbeing
      • • Community Service
    • • Describe the intended use of the $3000 prize money if successful. The expectation of the Award Selection Panel is that the prize money will be used for ongoing professional development.
    • Note: If you are nominating another person, the AMA (WA) will contact your nominee for this information


    • Max. file size: 8 MB.
    • Section E: Declaration by Proposer