2023 Volunteer of the Year Nomination Form

Nominate a deserving Operation Sight volunteer surgeon who has demonstrated outstanding dedication to Operation Sight patients, promotes cataract care accessibility, and actively engages in local philanthropic initiatives. Nominations must be for an Operation Sight volunteer currently registered or engaged with the program. Self nominations are accepted. If you are filling out this form on behalf of someone else, please complete to the best of your ability. Nominations will remain open through March 6th at 11:59pm EST. Winners will be recognized by the ASCRS Foundation during the 2023 Annual Meeting!
Nominator Information
Nominator Name*

First NameLast NameDegree(s)
Nominator Email*
Nominator Phone Number*

Area CodePhone Number
Relationship to Nominee
Nominee Information
Nominee Name*

First NameLast NameDegree(s)
Nominee Email*
Please include nominee's primary email address
Phone Number*

Area CodePhone Number
University Name
*Please do not use abbreviations
Medical Program Name
Current Organization Name*
*Please do not use abbreviations
Years involved in Operation Sight
Years in Practice
Please attach the nominee's CV as well as any additional patient testimonies you would like to share.

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Please provide a description of the nominee's exemplary charitable contributions to Operation Sight in 2022. Include examples of outstanding dedication to Operation Sight patients, how they might personify the charitable spirit of Operation Sight through their local participation, and any philanthropic work outside of Operation Sight.*

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Additional Details
Please utilize this space for any additional details or comments you would like to share about the nominee.

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Nominator Information

Nominee Information

Additional Details