Service Awards - Staff Nomination

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Nominee Information

Nominee Name*

First Name

Last Name

Department*

Title*

Degree Credential(s) [MD, PhD, etc.]

Nominee Email Address*

Nominee Phone*

Supervisor*

First Name

Last Name

Supervisor Email*

Supervisor Phone*

Nominee fits award criteria in the following ways:*

Only nominations meeting all criteria will be forwarded to selection committee for review.

Specific examples of how Nominee has gone above and beyond:*

Optional

Attach up to two one-page letters from colleagues, peers or others in support of the nomination.

Optional letter of support 1

No File Chosen

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Optional letter of support 2

No File Chosen

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Have you nominated this individual in previous years?*

Yes No

If you submitted a nomination last year, which was not selected for an award, you can resubmit for one additional cycle - the exception being the Rising Star Award, which requires a new submission. We encourage resubmitting worthwhile nominations as long as they meet the current criteria and describe what the nominee has done over the past 12 months.

Nominator Information

Name*

First Name

Last Name

Department*

Title*

Email*

Phone*

Nomination deadline: Monday, Sept. 11, 2023 at 11:59 p.m.

Nominee Information

Nominator Information