National Awards Nomination Form

Your Information

Welcome to the Kidney Foundation's National Awards nomination form!

Crucial information about your nominee, such as general contact information, as well as details related to their accomplishments will be required to complete the form.

Therefore, we strongly suggest that you gather and/or prepare your answers ahead of time in a text or Word document and copy/paste the information in the form once you are ready to complete it.

If you require any assistance to complete this form, please contact: recognitionawards@kidney.ca
Thank you!

1. Nomination Submitted By:

First Name *This question is required.

Last Name *This question is required.

Affiliation with the Kidney Foundation

Email Address *This question is required. This question requires a valid email address.

Phone Number *This question is required.

Cell Phone Number