2024 Immunization Champion Award Nomination Form

The Association of Immunization Managers (AIM) is a nonprofit membership association comprised of the directors of the 64 federally funded state, territorial, and local public health immunization programs. AIM members direct the public health efforts designed to keep children and adults vaccinated and protected against disease. AIM’s mission is to establish a nation free of vaccine-preventable diseases.

Step 1: Complete all fields below in the nomination packet electronically (preferred) or fill out a PDF version and email it to us.

Step 2: Complete the HHS consent waiver by certifying each statement with initials and signing the completed form:

• Print out the HHS consent waiver.
• Have the nominee initial the line before each statement, certifying that it is true.
• Have the nominee print their name and sign the document.
• Have a witness sign the document.
• Scan the waiver and email it to the program.

Step 3: Submit a clear color photo as a .png or .jpg.

Step 4: Submit the completed nomination packet and photo on the Champion Award webpage by May 28, 2024.  

AIM members: Please submit the nomination packet, HHS consent waiver, and photo of your selected Immunization Champion to [email protected] by June 28, 2024.

Please note that the Immunization Champion Award does not imply CDC endorsement of individuals’ commercial activity.

The Immunization Champion Award will honor up to one Champion from each of the 50 U.S. states, six cities, eight U.S. territories, and the District of Columbia. This award recognizes individuals who are working at the local level. It honors those doing an exemplary job or going above and beyond to promote or foster immunizations in their communities for both children and adults. When nominating and selecting their Champion, immunization programs will base their nominations on meeting one or more of the following criteria:

• Leadership: The candidate is considered an authority on immunization in their community, medical system, or individual practice. Activities may include acting as a spokesperson, trainer, mentor, or educator.
• Collaboration: The candidate has worked to build support for and increase immunization rates in adults and/or children. Activities may include establishing or strengthening partnerships, coalitions, committees, working groups, or others.
• Innovation: The candidate has used creative or innovative strategies to promote immunization or address challenges to immunization in their practice, community, state, or region. Activities may include implementing new strategies and adapting existing strategies in new ways, such as reaching under-immunized populations.
• Advocacy: The candidate actively advances policies and best practices to support immunization in adults and/or children in their community, state, or region.

Immunization Champions may include coalition members, parents, healthcare professionals (e.g., physicians, pharmacists, nurses, physicians’ assistants, nurse practitioners, medical assistants), community activists, nonprofit leaders, and community-based organization members.

Immunization program managers, county, state, and federal government employees paid by state or federal immunization funding, individuals who have been affiliated with and/or employed by pharmaceutical companies, and those who have already received the award are not eligible to apply.

Once the nomination period has ended, AIM will send all received nominations to their respective jurisdictions for review and selection of a Champion.

Nominations will be accepted from all 50 U.S. states, six cities, eight U.S. territories, and the District of Columbia. Nomination forms can be completed on the Champion Award webpage on the AIM website. Self-nominations are welcome. The Nomination Period opens April 10, 2024, and closes May 28, 2024.

The nomination form requires a photograph and a completed nomination narrative. These items will be used for the promotion of selected Immunization Champions. The packet includes an HHS consent waiver that must be printed, initialed, signed, and either emailed or mailed with the nomination packet. Additional optional supporting materials, including program materials, publications, news clippings, and website screenshots, may be submitted.

Immunization programs that choose to participate in the AIM Immunization Champion Award will evaluate all nominees and recommend one individual to receive the award based on the criteria listed above. Each jurisdiction will notify AIM of their selection by June 28, 2024. AIM will review and confirm the recommendations and issue the awards.

• Awards will be announced in early August to celebrate National Immunization Awareness Month (NIAM).
• Each awardee will receive an Immunization Champion Award plaque.
• Immunization Champions and their accomplishments will be featured on the AIM and CDC websites.

Learn more online at https://www.immunizationmanagers.org/championsaward

1 NOTE: AIM may not confirm the recommendation if the nominee does not meet award criteria and/or eligibility guidelines.

To complete the HHS consent waiver, which can be downloaded here, please certify each statement with initials, sign the completed form, and submit it at the end of the nomination form below.