TPS Award Nomination Form

Once again, we have a special opportunity to recognize and say thanks to colleagues and friends who have served as advocates for children.  Please take the time to help us acknowledge those who work on behalf of pediatrics.

Everyone has a colleague or friend that has served as an advocate for children above and beyond – now is that special opportunity to recognize and say thank you by nominating them for one of the awards below.  Please take the time to help TPS identify possible recipients.  Your testimony and recommendation are important, as we may not be aware of all the work being done for Texas children.   Award winners will be honored at the TPS Annual Meeting Awards Luncheon to be held Saturday September 21, 2019 at the Renaissance Dallas in Plano.

You may submit a nominee for each award. Each award has an area for you to submit the nominee. Before nominating someone please check the TPS AWARD WINNERS: 1941 - present to make sure they are not a previous recipient of the award for which you are nominating them.

  • Sidney Kaliski Award of Merit-This award recognizes a member of the Texas Pediatric Society who has served as an advocate for children and has made a substantial contribution to both the health and welfare of the children of Texas and to the Texas Pediatric Society.
  • Distinguished Service Award-This award recognizes a non-member pediatrician, non-pediatric physician, allied health care provider or a layperson who has gone beyond the norm in expressing their dedication and love of children.
  • Early Career Physician’s Award-Recognizes a TPS member resident or early career physician for exemplary service to the Texas Pediatric Society. An “early career physician” nominee is one who is less than 40 years of age or who has been in practice five years or less.

The deadline for submitting nominations for the TPS Awards is 5 pm on Monday, April 15, 2019. If you do not wish to submit this electronic form you may download the paper form here. If you are a TPS member, please log in to the website before beginning the form.  The log in button is found on top banner menu.  Logging in to our system will allow you to save a draft for completion at a later time (available for TPS members only).  If you need information on your username and password, contact Crystal Healey at crystal.healey@txpeds.org or at 512-370-1517.

Numbers only please, no dashes or parenthesis are necessary.
Select the award for which you are submitting a nomination.
List the full name of the person being nominated.
List a few of the recognized achievements of the nominee in the care of children that you feel would qualify him/her for this award.
If you do not have a CV and would like to email it to us later, send it to tricia.hall@txpeds.org.
Files must be less than 10 MB.
Allowed file types: gif jpg jpeg png rtf html pdf doc docx.
If you do not have a CV and would like to email it to us later, send it to tricia.hall@txpeds.org.
Files must be less than 800 bytes.
Allowed file types: gif jpg png rtf html pdf doc docx.
This is a required field. Full address (street number, street name, city, and ZIP)
This is a required field. Numbers only please, no dashes or parenthesis are necessary.
This is a required field. You may submit their personal or work email. _______________________________________________________________________________________________________
List the full name of the person being nominated.
List a few of the recognized achievements of the nominee in the care of children that you feel would qualify him/her for this award.
If you do not have a CV and would like to email it to us later, send it to tricia.hall@txpeds.org.
Files must be less than 10 MB.
Allowed file types: gif jpg jpeg png rtf html pdf doc docx.
If you do not have a support letter and would like to email it to us later, send it to tricia.hall@txpeds.org.
Files must be less than 800 bytes.
Allowed file types: gif jpg jpeg png rtf html pdf doc docx.
This is a required field. Full address (street number, street name, city, and ZIP)
This is a required field. Numbers only please. Do not use dashes or parenthesis.
This is a required field. You may submit their personal or work email. _______________________________________________________________________________________________________
List the full name of the person being nominated.
List a few of the recognized achievements of the nominee in the care of children that you feel would qualify him/her for this award.
If you do not have a CV and would like to email it to us later, send it to tricia.hall@txpeds.org.
Files must be less than 10 MB.
Allowed file types: gif jpg jpeg png rtf html pdf doc docx.
If you do not have a support letter and would like to email it to us later, send it to tricia.hall@txpeds.org.
Files must be less than 800 bytes.
Allowed file types: gif jpg jpeg png rtf html pdf doc docx.
Full address (street number, street name, city, and ZIP)
This is a required field. Numbers only please. Do not use dashes or parenthesis.
This is a required field. You may use their personal or work email.
Please make sure your submissions include the nominee's preferred mailing address, phone number and email.