Linda Saltzman Award Candidate Submission Form



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Thank you for using this electronic form to nominate a qualified candidate for the National Conference on Health and Domestic Violence's 2017 Linda Saltzman Award! 

Award sponsors Futures Without Violence, The Center for Disease Control and Prevention (CDC), Raliance and a committee of experts will select one outstanding individual to receive the award at our 2017 National Conference on Health and Domestic Violence in San Francisco, CA. 

Click here for additional information and to review the instructions prior to completing your submission

In order to be a candidate, the individual must be able to attend the entire 2-day conference (September 27-28, 2017) in San Francisco, CA with optional Pre-Conference Institute attendance on September 26, 2017.

Please fill out the candidate's Information: 








(Maximum response 255 chars, approx. 5 rows of text)



Documents Required: please submit the following documents to Melody Pagan at immediately after completing this form.

I. The candidate's resume or CV (listing research project involvement and any publications) in PDF format
II. A narrative (Word document, 2 pages max, 1.5 spacing) addressing the questions designated below. The awardee will be selected based on the quality of their research and its implications for the field; commitment to underserved communities; mentorship and collaboration with fellow researchers, health providers and advocates in the field.

In your narrative, address the following:

A. Describe the candidate's relevant employment, educational and/or graduate school program, their area of focus and its relevance to this award, Dr. Saltzman and/or this field.
B. Describe the candidate's work on domestic violence or sexual assault prevention/intervention/research/advocacy/etc. Highlight work with underserved communities, if applicable.  
Note: Submissions received without these accompanying documents may be considered incomplete and withdrawn from consideration.

9. Kindly provide your information as the person nominating a candidate:















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