Dr. Carl Blank Award Nomination Form

  • The Dr. Carl Blank Award was established by the Wyoming Public Health Association in 2004 to honor those members who have distinguished themselves in the field of public health, and who have, through their membership, made a significant contribution to the Wyoming Public Health Association. Dr. Carl Blank became the director of the Wyoming Public Health Laboratory in 1992 as a federal employee working for the US Centers for Disease Control and Prevention. Dr. Blank retired from federal service in 1995, but continued as the lab director until the position could be filled by the State of Wyoming in 1996. Dr. Blank then acted as the director of the American Public Health Laboratories in Washington, D.C. until 1997 and returned to Wyoming to again serve as lab director in 1998. Dr. Blank served as the state liaison with the Wyoming Board of Embalmers. He was an active member of the American Public Health Association (APHA) for more than 40 years. Dr. Blank was the first president of the Wyoming Public Health Association, and then later served WPHA as a registered lobbyist. He was honored with a Lifetime Achievement Award in 1998 and recognized by APHA as a Laboratorian of the Year. Sadly, Dr. Blank lost his battle with cancer in 2002.

    AWARD CRITERIA:
    Nominee must be a current active member of the Wyoming Public Health Association. Nominee must have distinguished him/herself by making a significant contribution to the Wyoming Public Health Association in at least one of the following ways:
    • Distinguished him/herself in the field of public health by making an outstanding contribution that is innovative or creative;
    • Displayed leadership in the field of public health and served as a mentor to others in the field;
    • Demonstrated a strong commitment to collaborative professional activity and teamwork;
    • Displayed outstanding professional integrity and respect.
  • Accepted file types: pdf, doc, docx, txt.
    In addition to this form, please attach a one-page narrative summary of why you are nominating this individual to receive this award. Your narrative must address at least one of the award criteria listed above.