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Nomination form: Dr. Ashok Muzumdar Memorial Award for Physicians with Disabilities

Dr. Ashok Muzumdar Memorial Award

Please complete this form to nominate an individual for the Dr. Ashok Muzumdar Memorial Award for Physicians with Disabilities (including learners).

This award shall be presented to a CMA member with a disability, whether physical, cognitive or psychological, who embodies the resilience demonstrated by Dr. Muzumdar and who has demonstrated outstanding leadership abilities in one or more of the following ways: 
  • advocating for and effectively influencing positive changes at the regional, national and/or international level for patients and/or physicians with disabilities
  • encouraging and facilitating the development of more equitable supports (e.g., facilities, assistance or funding) for patients and/or physicians with disabilities¬†
  • acting as an effective role model and/or mentoring physicians and learners with disabilities
  • improving the quality of care and enhancing the quality of life for people with disabilities
  • educating the public regarding the many facets of disabilities

If you would like to nominate more than one individual, each nomination must be entered on a separate nomination form. To do this, simply click on the link to the nomination form from the award page again.

Click "Next" to proceed.

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