BCDHA Student Award Recipient Submission Form

Thank you for submitting your program's BCDHA Academic Award recipient information.

Please complete this form once your award recipient(s) have been selected. The information provided will be used by BCDHA to prepare the recipient's award certificate and coordinate award presentation details.

Please submit award recipient information at least four weeks prior to the award presentation date to allow sufficient time for processing and, where possible, to arrange for a BCDHA representative to attend the presentation.

Institution and Program Details

Contact Information

Name
Additional Contact, if applicable:

Award Recipient Details

Award Recipient's First Name:
Please enter the name exactly as it should appear on the award certificate.
Is there more than one recipient for this award?

Award Presentation and BCDHA Representation

BCDHA will arrange for a representative to attend your institution's award ceremony and present the BCDHA award. Please provide the following information to support scheduling and coordination.

Date of Award Presentation/Ceremony
Please provide the venue/building name and full address.
On-site Contact Name
Please include any information that would be helpful to the BCDHA representative, such as arrival time, where to check in, parking information, ceremony schedule or presentation protocol.

Recipient Photo and Media Release

BCDHA requests a photo of the award presentation for possible inclusion in BCDHA communications, including the website, social media and newsletters. A completed BCDHA media release is required before identifiable recipient photos can be shared.

Max. file size: 8 MB.
Please indicate the status of the recipient's BCDHA media release

Additional Information

Please review all information carefully before submitting, particularly the spelling of the recipient's name, as this information will be used to prepare the BCDHA award certificate.

Upon submission, the information will be sent to the BCDHA Manager of Practice and Education for processing. Please allow up to four weeks prior to the presentation date to provide adequate processing time and allow BCDHA the opportunity to arrange for a representative to attend the award presentation. BCDHA representation is subject to availability.