GloPAKH - Kidney Health Expert Patient Advocacy Academy - Global Patient Alliance for Kidney Health

Full name of nominator*

Preferred email of nominator*

Organization of nominator*

Do you hold a position at said organization? If so, please add it below.

Preferred email of Nominee*

Age of nominee*

If no, what languages does the nominee speak? Add all of them below.

Tell us a little about the nominee? Why do you think they would be a good advocate and trainee for this academy?*

Is there anything else you would like for us to know about the nominee?*

Please upload a headshot or other photo of nominee.

Accepted file types: jpg, jpeg, png, Max. file size: 50 MB.

If applicable, please add links to nominee's social media handles.

KIDNEY HEALTH EXPERT PATIENT ADVOCACY ACADEMY NOMINATION FORM