Ambassador of the Year Nomination Form

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Please complete each field to have your nomination considered for this prestigious honor.

All applications are due by December 31.

The submitted information will be reviewed by the U.S. Pain Foundation nomination committee, which will announce the recipient of the Joselynn Badman Ambassador of the Year Award in February. A point system will be used to determine the level of involvement, accomplishments and outstanding volunteerism.

Before filling out the application, please read the criteria to ensure your nomination is eligible.

The nominee must:

Be an active and current Pain Ambassador, Advocate or volunteer for U.S. Pain Foundation for the award year, and:

  • Carry out respectful and effective communication among peers and within the pain community
  • Motivate others within the Pain Ambassador and Advocacy programs to excel
  • Demonstrate willingness to achieve the mission of U.S. Pain Foundation
  • Exhibit innovative approaches to raise awareness and/or accomplish advocacy goals of the organization

Your First Name:
Your Last Name:
Your Email:
Name of the person you are nominating:
Email, if available, of the person you are nominating:
How has this person positively impacted U.S. Pain Foundation?:
Provide three examples of how this person has participated in awareness programs/campaigns and/or advocacy initiatives:
What results were accomplished through this person’s pain awareness/advocacy efforts?
Provide an example of how this person has made additional contributions to the pain community, either through community service/volunteerism, promoting community enhancements for the greater good of the pain community, or other positive achievements not yet outlined in the application form:
Why do you feel this person should be awarded the Joselynn Badman Ambassador of the Year Award?

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