SECTION ON PEDIATRICS
KNOWLEDGE TRANSLATION LECTURESHIP
NOMINATION FORM
CRITERIA:
The Section on Pediatrics hosts a tri-annual Knowledge Translation (KT) Lecture at the
Combined Sections Meeting. The purpose of this lecture is to highlight the dynamic relationship
between pediatric clinical practice and pediatric related research. This lecture is a two-person
presentation by a pediatric researcher and pediatric clinician. If a pediatric researcher is
nominated, he/she shall select a pediatric clinician co-presenter. If a pediatric clinician is
nominated, he/she shall select a pediatric researcher co-presenter.
The award recipient shall be a current Section on Pediatrics member. The nomination should
include supporting evidence for the following criteria:
1) Highly skilled pediatric clinician or pediatric researcher,
2) Excellence in presentation,
3) Significant impact on the practice of pediatric physical therapy, and
4) Collaborative relationship with pediatric clinician (if the invitee is a researcher) or pediatric
researcher (if the invitee is a clinician).
Nominations should be sent to the Executive Office (pediatrics@apta.org) electronically by
October 1 and should include: 1) this completed form, 2) a letter of nomination that specifically
addresses each of the award criteria, and 3) the nominee’s curriculum vitae.
The following individual is nominated for the Knowledge Translation Lectureship Award:
NOMINEE (you may nominate yourself)
Name: __________________________________________________________________
Complete Mailing Address: _________________________________________________
City: _______________________________ State: ___________Zip:________________
Phone: _________________________E-mail: __________________________________
Why is this person nominated? (Please use separate sheet of paper)
NOMINATOR
Name: __________________________________________________________________
Complete Mailing Address: _________________________________________________
City: ______________________________State: ___________ Zip: _________________
Phone: ________________________E-mail:____________________________________
Signature of Nominator: _____________________________Date: _________________
Please send materials to pediatrics@apta.org no later than OCTOBER 1.
Developed 5/15
SECTION ON PEDIATRICS
ANN VANSANT GLOBAL SCIENTIFIC WRITING LECTURESHIP
NOMINATION FORM
CRITERIA: The Section on Pediatrics hosts a rotating series of lectureships at the Combined
Section Meeting (CSM). The purpose of the Ann VanSant Global Scientific Writing Lectureship
is to create a forum for a leader in development or pediatrics to communicate and inspire on the
importance of science and scientific writing in the advancement of pediatric physical therapy. The
lectureship recipient shall be a current Section on Pediatrics member; the nomination should
contain supporting evidence for the following criteria: 1) demonstrated collaboration with
physical therapists from other countries to advance pediatric physical therapy science, education,
exchanges, or programs; 2) sustained and continuous leadership contribution over a period of not
less than 10 years; 3) demonstrated leadership in scientific writing through published articles,
lectures, or mentorship to authors of publications for global pediatric physical therapy practice; 4)
recognition by peers for her/his scientific writing and presentations to pediatric physical therapists
worldwide; and 5) ability to present a noteworthy lecture; acknowledged skills in the organization
and presentation of written and oral communications.
Nominations should be sent to the Executive Office (pediatrics@apta.org) electronically by
October 1 and should include: 1) this completed form, 2) a letter of nomination that specifically
addresses each of the award criteria, and 3) the nominee’s curriculum vitae. The announcement of
who will be the following year’s lectureship recipient occurs at the Section’s Business Meeting
during CSM.
NOMINEE (you may nominate yourself)
Name: __________________________________________________________________
Complete Mailing Address: _________________________________________________
City: _______________________________ State: ___________Zip:________________
Phone: _________________________E-mail: __________________________________
Why is this person nominated? (Please use separate sheet of paper)
NOMINATOR
Name: __________________________________________________________________
Complete Mailing Address: _________________________________________________
City: ______________________________State: ___________ Zip: _________________
Phone: ________________________E-mail:____________________________________
Signature of Nominator: _____________________________Date: _________________
Please send materials to pediatrics@apta.org no later than OCTOBER 1.
Developed 5/15
SECTION ON PEDIATRICS
DIANNE CHERRY EDUCATORS’ LECTURESHIP
NOMINATION FORM
CRITERIA: The Section on Pediatrics hosts a rotating series of lectureships at the Combined
Section Meeting (CSM). The purpose of the Dianne Cherry Educators’ Lectureship is to to
provide a forum for clinical and academic faculty to discuss topics relevant to the unique
educational issues surrounding pediatric physical therapy. The lectureship recipient shall be a
current Section on Pediatrics member; the nomination should contain supporting evidence for the
following criteria: The chosen topic should reflect current issues in pediatric professional physical
therapy education and may be related to academic faculty needs, academic curricula, or clinical
faculty needs.
Nominations should be sent to the Executive Office (pediatrics@apta.org) electronically by
October 1 and should include: 1) this completed form, 2) a letter of nomination that specifically
addresses each of the award criteria, and 3) the nominee’s curriculum vitae. The announcement of
who will be the following year’s lectureship recipient occurs at the Section’s Business Meeting
during CSM.
NOMINEE (you may nominate yourself)
Name: __________________________________________________________________
Complete Mailing Address: _________________________________________________
City: _______________________________ State: ___________Zip:________________
Phone: _________________________E-mail: __________________________________
Why is this person nominated? (Please use separate sheet of paper)
NOMINATOR
Name: __________________________________________________________________
Complete Mailing Address: _________________________________________________
City: ______________________________State: ___________ Zip: _________________
Phone: ________________________E-mail:____________________________________
Signature of Nominator: _____________________________Date: _________________
Please send materials to pediatrics@apta.org no later than OCTOBER 1.
Developed 5/15