2025 DoM Staff Awards Nomination Form

2025 Staff Awards Nomination Form

Your Information
Name*
First Last Suffix
Your DOM Section*
Email*
Staff Award*
- David Aaron Freed Compassion & Excellence Award
- Maria Antoinette Evans Staff Diversity Award
Nominee's Information
Name*
First Last Suffix
Section within DOM*
Job Title*
Email*
Maria Antoinette Evans Award Nomination Critera
Nominee should be a non-faculty member of the Department of Medicine for at least a year who exemplifies the following qualities: Models inclusive behavior, Commitment to educating peers in DEIA topics, Mentoring, Creates, initiates or supports DEIA program development, and Goes above and beyond normal job expectations. Please provide SPECIFIC EXAMPLES for each of these categories.
Models Inclusive Behavior*
Please provide specific examples
Commitment to Educating Peers on DEIA Topics*
Please provide specific examples
Mentoring*
Please provide specific examples
Creates, initiates or supports DEIA program development*
Please provide specific examples
Goes Above & Beyond Job Expectations*
What are they doing outside of their job description? Please provide specific examples.
David "Aaron" Freed Award Nomination Criteria
Nominee should be a non-faculty member of the Department of Medicine for at least a year who demonstrates the following qualities: Dedication to the community, Selflessness, Dependability, Compassion, and Goes above & beyond expectations (outside of their job description). Please provide SPECIFIC EXAMPLES for each of these categories.
Dedication to the Community*
Please provide specific examples
Seflessness*
Please provide specific examples
Dependability*
Please provide specific examples
Compassion*
Please provide specific examples
Goes above and beyond their normal job duties*
Please provide specific examples
Overall Impact*
Please indicate the overall impact of this candidate's dedication to bettering the everyday experience of those in the DOM community.
Additional Evaluators
Name*
First Last
Email*
Name*
First Last
Email*
Name*
First Last
Email*