ASAV Roger Clarke
Practitioner of the Year Award

NOMINATION FORM

As we are unable to save progress of answers on this nomination form, please ensure that you have all related submission documents available before you commence the application.

Applications close on Friday 4 July 2025, 5:00pm AEST.

Nominee Details
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Nominator Details
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Essential criteria:

• Be actively engaged in practice with a component of at least 50% focus on small animals, for a minimum period of five years and be a member of good standing.

• Is a practitioner, who in the eyes of their colleagues or the wider profession, demonstrates outstanding service to the profession and the public through academic pursuits, standard of practice, professional profile, altruism or a combination of these components.

• Nominations are to be supported by testimonials from colleagues. Testimonials from the public supporting the nomination are also welcome.

In addition, the following criteria will further qualify a worthy recipient of this award:

• Is a practitioner who has rendered an outstanding level of mentoring, support, or leadership to colleagues.

Testimonials

Please include the testimonial name and relationship to the nominee.