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Nomination Form

Rock Doc and AMP (Affiliated Medical Professional) Champ Nomination Form

  • Nominations will be reviewed and the Rock Docs/AMP Champs will be determined by the Illinois CancerCare Foundation Advisory Board.
  • The presence of the Rock Doc/AMP Champ winners at the CUREageous event on Friday, November 15, 2019 is required.
  • Nominations are not valid from year to year but previously nominated physicians may be re-submitted for consideration.
  • All forms must be returned by May 31, 2018.

  • Your Information

  • Rock Doc Information

  • Rock Doc Oustanding Alumni Information

  • AMP Champ Information

  • Nomination

    Tell us why you think your nominee(s) rocks in the field of research and outstanding patient care. Please elaborate on your nominee's research involvement. If you are unaware of your nominee's effort in research, the Rock Doc Committee will review the nominee's involvement.
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