LGBTQIA+ Award Nomination Form

Candidate’s Information

Candidate's Name

Candidate's Email Address

Candidate's Credentials

Candidate's Address

Candidate's Primary Phone

Candidate's Primary Occupation

Candidate's Secondary Occupation

Candidate's Education

Please list the degrees the candidate has earned or the academic program in which they are currently enrolled. Please include the institution, city, state and the year for each degree listed.

NATA Membership Number

Those without NATA membership will not be considered.

NPI Number

Those without NPI number will not be considered.

Candidate's CV or Resume

Please upload an updated copy of the candidate's CV or resume that outlines their scholarly and service activities.
One file only.
2 MB limit.
Allowed types: pdf doc docx.

Nominee LGBTQIA+ Contributions

Candidate’s Contributions to the Advancement of the LGBTQIA+ Community

This may include scholarship or service, provision of care to individuals or populations, inclusion for colleagues or athletic training students.

Letters of Recommendation

Upload up to two letters of recommendations that address impact of individual’s accomplishments within the LGBTQ+ community.
One file only.
10 MB limit.
Allowed types: txt html pdf doc docx ppt pptx xls xlsx.

LGBTQIA+ Award Nomination Form

NATA EducATe: New Courses in September 2026