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Home
Membership
Membership
Dues Scale
Calendar
Seminars / CE
Seminars / CE
Indiana Optometry CE Requirements
About Us
About Us
Mission and Vision
History
Awards
Awards Criteria & Nomination Forms
Officers
Trustees
IOA Society Presidents
IOA Society Map
Staff
Disclaimer and Privacy Notice
Advocacy-PAC
Advocacy-PAC
Current Legislative Session
Legislator Finder
Senate & House Committees
Doctor Resources
Classified Ads
Sponsorship
Find A Doctor
Patient Resources
Contact Us
Member Login
Lifetime Achievement Nomination Form - Indiana Optometric Association
Please scroll down the page to complete the form. LIFETIME ACHIEVEMENT AWARD: The Lifetime Achievement Award is presented to an Optometrist or Non-Optometrist in recognition of contributions to optometry over the whole of their careers. Qualifications 1. Public Service (25 points): A. Service to the country, state, or other political subdivision in any capacity B. Service to education C. Service to the community D. Service to religious or service institutions E. Service to charitable causes F. Philanthropy 2. Service to the Visual Welfare of the Public (25 points): A. Service with sight-saving groups B. Activity with governmental health care programs C. Participation in public service programs, i.e., visual screening projects, etc. D. Legislative activities beneficial to the visual welfare of the public 3. Service to Optometry (25 points) A. Contributions of personal effort and time in behalf of the profession's advancement B. Educational and research activities C. Contributions to profession's literature D. Similar acts of service 4. Service to the AOA, IOA and its Affiliates (25 points): A. Service as an officer, committee chair, committee member, etc. B. Promotion of the association's goals and programs C. Activity in support of the association's organizational projects D. Involvement in public relations activities E. Similar acts of service
*
- Required Field
First Name *
Last Name *
Email *
Please provide the name of your nominee for the Lifetime Achievement Award
Nominee's City and State
Nominee's Email
Nominee's Phone
Please describe the public service in which the nominee has engaged (25 points)
Please describe the service to the visual welfare of the public in which the nominee has engaged (25 points)
Please describe the nominee's service to Optometry (25 points)
Please describe the nominee's service to the AOA, IOA and its affiliates (25 points)
Additional comments
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