Resident, Alumni, and Faculty Nominations

Thank you for taking the time to recognize excellence in a colleague, supervisor, or subordinate.  We welcome any program director, department chair, or active AOA member in the Federal Health System to nominate a faculty member, resident, fellow, or USU alumnus for full AOA membership.  Please fill out the following form, and paste your letter of recommendation into the appropriate field.  Once we receive your nomination, we will contact the applicant directly to help them complete their candidacy packet.  You may only nominate one candidate per calendar year.

In addition to submitting the following form please email,, and/or with the nominee's email address.

You can use the "locate a member" option on the national AOA website to determine whether someone is already an AOA member (we recommend you select the "all members" option if your initial search yields no results). 

Please follow all directions carefully, and be advised that there is no save feature on this form, so we suggest copying and pasting your letter from a saved document. If you encounter difficulties submitting this document you may email your letter of recommendation and candidate’s CV (if available) to

Honor Statement *
I hereby affirm that all of the information I am going to report in this form is truthful to the best of my knowledge, and that I am eligible to nominate by the guidelines stated above.
Your Information
Your Name *
Your Name
If you are not a program director or department chair, you must provide an AOA Membership Number to verify your eligibility to nominate.
Nominee Information
Nominee's Name *
Nominee's Name
Nominee's Phone Number
Nominee's Phone Number
This will be our backup means of contacting the nominee. Please use numbers only, no punctuation or spaces.
This is important to verify the applicant's eligibility to be nominated.
Please let us know the field in which the nominee works.
Please copy and paste your letter of recommendation here, detailing your reasons for nominating this candidate. Application packages are evaluated based on five areas: scholarship (i.e. academic achievement/research), leadership, service, professionalism, and teaching/mentoring.
We do not inform candidates of the source of their nomination as a matter of course, but if you would like us to ensure that your nomination is kept anonymous, please select "yes."