Margaret Kohli Award Nomination Form

Recipients of the Margaret Kohli Award for Outstanding Alumni Contributions are chosen for their contributions to the physical therapy profession through clinical practice, education, research or service.

Award nominations are due by October 1. The recipient of the award will be notified by November 1 and the award will be presented at the University of Wisconsin–Madison Physical Therapy program’s alumni function, at the Combined Sections Meeting of the American Physical Therapy Association.

"*" indicates required fields

Nominator Contact Information

Name*

First Last

Email*

Phone*

Nominee Information

Name*

First Last

What year did they graduate from the UW–Madison Physical Therapy program?*

Why is this person deserving of the Margaret Kohli Award?*

Describe their contributions to the physical therapy profession through clinical practice, education, research or service.

CV/Resume (as PDF)*

Accepted file types: pdf, Max. file size: 2 MB.