Nominee
JANE DOE
Nominator
JOHN SMITH
How long have you know the nominee 3-5 YEARS and in what capacity COLLABORATOR
AND COLLEAGUE .
Please check the Award for which you are nominating the candidate:
OUTSTANDING SERVICE TO THE INSTITUTION
Please highlight the accomplishments or actions that demonstrate the nominee’s
fulfillment of the requirements for this award. A bulleted list of 250 words or less is
recommended.
• R01 funded
• Successfully mentored 3 PhD students
• Aesculapian award for teaching
• Member faculty assembly
• Member strategic plan committee
• 3 peer reviewed publications this year
In three sentences or less, please describe the added value of the nominee to the
institution due to these accomplishments or actions.
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