2025 Washington Freeman Peck Award Nomination Form

This award is given to a lay organization to honor their contributions to public health. This award is named after Dr. Washington Freeman Peck, the principal agent behind the establishment of the State University of Iowa Medical Department in Iowa City, the institutional forebear of the University of Iowa Carver College of Medicine.

Please submit nominations by January 26, 2025.

The survey will take approximately 5 minutes to complete. If you would like to send additional material, please email the information to gfleming@iowamedical.org by the deadline.

Fields marked with an * are required.

Name of nominee *

Nominee email *

Nominee Address *

Nominee City, State, Zip *

Nominee Phone Number *

Why should this organization be considered for the award? Check all that apply. *

Demonstrated a significant contribution to the success of public health

Demonstrated outstanding innovation in this field

Recognized as an outstanding advocate for public health

Other reasons for consideration:

Please provide examples or supporting information about this nomination

Nominator name *

Nominator email or phone number *

If requested by the nominee, can we share this information with them? *

Yes

Please verify that you have checked the “I'm not a robot” checkbox.