<p>
	<img alt="" src="http://www.aapsus.org/userfiles/images/sullivanaward(1).jpg" style="width: 250px; float: left; height: 300px" /></p>
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		<strong><span style="font-size: 16px">Louis W. Sullivan, M.D. Health Policy Leadership Award</span></strong></p>
	<p>
		The American Association of Physician Specialists, Inc. (AAPS) is accepting nominations for the first annual &quot;Louis W. Sullivan, M.D. Health Policy Leadership Award&quot; named in honor of Dr. Louis W. Sullivan, former Secretary of the U.S. Department of Health and Human Services (1989-93) and founder of the prestigious Morehouse School of Medicine in Atlanta. Dr. Sullivan is a public member of the AAPS Board of Directors.</p>
	<p>
		Candidates for the Sullivan Award shall have, or are in the process of establishing a truly outstanding contribution through an initiative to improve the health status of individuals, targeted groups and communities within the nation or internationally. The candidate may have a primary role either within, or outside the public health sector. Nominees are required to meet a least one of the following criteria:</p>
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	<p>
		<strong>Criteria:</strong></p>
	<ul>
		<li>
			Did the candidate serve as a champion in promoting major health policy changes?</li>
		<li>
			Did the candidate use innovative methods of promoting public health policies to targeted stakeholders?</li>
		<li>
			Is the candidate, a policy originator who affected major health policy legislation?</li>
		<li>
			Did the candidate advocate for health policy improvements?</li>
		<li>
			Has the candidate been recognized for any distinguishing achievements related to health policy?</li>
	</ul>
	<p>
		<strong>Deadline for submissions is April 30, 2012. Winners will be announced June 26 at the Annual Meeting of the American Association of Physician Specialists&reg;, in Marina del Rey (Los Angeles).<br />
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		</strong></p>
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		<table border="0" cellpadding="2" cellspacing="0" width="100%">
			<tbody>
				<tr>
					<td colspan="2">
						<strong>Nominee contact information:</strong></td>
				</tr>
				<tr>
					<td align="right" width="15%">
						<font color="#ff0000">Name:</font></td>
					<td align="left" width="85%">
						<input autocomplete="OFF" id="NominationName" maxlength="255" name="data[Nomination][name]" /></td>
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				<tr>
					<td align="right">
						<font color="#ff0000">Address:</font></td>
					<td align="left">
						<input autocomplete="OFF" id="NominationAddress" maxlength="255" name="data[Nomination][address]" /></td>
				</tr>
				<tr>
					<td align="right">
						<font color="#ff0000">Email:</font></td>
					<td align="left">
						<input autocomplete="OFF" id="NominationEmail" maxlength="255" name="data[Nomination][email]" /></td>
				</tr>
				<tr>
					<td align="right">
						<font color="#ff0000">Phone:</font></td>
					<td align="left">
						<input autocomplete="OFF" id="NominationPhone" maxlength="255" name="data[Nomination][phone]" /></td>
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				<tr>
					<td colspan="2">
						In 100 words or less, please explain how the nominee meets or exceeds the award criteria.</td>
				</tr>
				<tr>
					<td align="right" valign="top">
						<font color="#ff0000">Details:</font></td>
					<td align="left">
						<textarea cols="30" id="NominationDescription" name="data[Nomination][description]" rows="6"></textarea></td>
				</tr>
				<tr>
					<td colspan="2">
						Upload photo of nominee:</td>
				</tr>
				<tr>
					<td align="right" valign="top">
						Image</td>
					<td align="left">
						<input id="NominationImage" name="data[Nomination][image]" type="file" /></td>
				</tr>
				<tr>
					<td colspan="2">
						Upload bio of nominee:</td>
				</tr>
				<tr>
					<td align="right" valign="top">
						Bio</td>
					<td align="left">
						<input id="NominationBio" name="data[Nomination][bio]" type="file" /></td>
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				<tr>
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						<strong>Submitter contact information:</strong></td>
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				<tr>
					<td align="right">
						<font color="#ff0000">Name:</font></td>
					<td align="left">
						<input autocomplete="OFF" id="NominationSubmitterName" maxlength="255" name="data[Nomination][submitter_name]" /></td>
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				<tr>
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						<font color="#ff0000">Address:</font></td>
					<td align="left">
						<input autocomplete="OFF" id="NominationSubmitterAddress" maxlength="255" name="data[Nomination][submitter_address]" /></td>
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				<tr>
					<td align="right">
						<font color="#ff0000">Email:</font></td>
					<td align="left">
						<input autocomplete="OFF" id="NominationSubmitterEmail" maxlength="255" name="data[Nomination][submitter_email]" /></td>
				</tr>
				<tr>
					<td align="right">
						<font color="#ff0000">Phone:</font></td>
					<td align="left">
						<input autocomplete="OFF" id="NominationSubmitterPhone" maxlength="255" name="data[Nomination][submitter_phone]" /></td>
				</tr>
				<tr>
					<td align="right">
						<font color="#ff0000">Security Key:</font></td>
					<td align="left">
						<img alt="" id="captcha_image" src="/pages/captcha/image.png" />
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							<input id="NominationCaptcha" name="data[Nomination][captcha]" /></div>
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				<tr>
					<td align="right">
						&nbsp;</td>
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							<input type="submit" value="Submit" /></div>
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