2024 Annual Faculty Awards Nomination Form

Nominee Name*

First Last

Nominee Email*

Nominee's Section*

Nominator's Name*

First Last

Nominator's Email*

Nominee's Section Chief Name*

First Last

Faculty Award*

Please select only one award. If you would like to submit a faculty member for multiple awards, you will need to complete a separate form. Note: If you are nominating a faculty member for the Outstanding Citizenship Award, you MUST provide at least 3 people who are willing to write a letter of support for the nominee (Space available below).

Nomination Letter*

Please attach a letter that includes a detailed justification for you nomination where prompted below. You may address your letter to the DoM Awards Committee. Winners will be announced at the DoM Evans Days annual dinner in the fall. Nominations are due by May 31, 2023.

Max. file size: 100 MB.

Name of Letter Writer 1*

If you are nominating a faculty member for the Outstanding Citizen Award, you MUST provide 3 names and emails of people willing to write letters of support for the nominee. Please indicate three people that are closely familiar with this faculty member's work.

First Last

Email of Letter Writer 1*

Name of Letter Writer 2*

First Last

Email of Letter Writer 2*

Name of Letter Writer 3*

First Last

Email of Letter Writer 3*

Additional Letter Writers