UTMB Dept. Pediatrics
Pediatric Education Awards
Excellence in Student Education
Nomination Form
Directions:
Complete this form. Save and notice where you saved it.
Upload as an e-mail attachment to Virginia Niebuhr vniebuhr@utmb.edu
We request you make every effort to keep this nomination secret from the nominee.
Pediatric Educator Award for Excellence in Student Education
This award honors a Pediatric Faculty member who has made a significant contribution to Pediatric Student education.
Qualifications:

The nominee must be a UTMB Faculty member.

The nominee must have given at least two (2) years of service to the Department of Pediatrics’
educational mission.

Previous awardees may be considered but not in consecutive years and only if new contributions have
been made since the time of the previous award.
Previous awardees: www.utmb.edu/pedi_ed/AWARDS/awardees.htm
Nominee:
Description of this faculty’s contribution to student education. (expandable box)
Explanation of why you think this nominee deserves this award. (expandable box)
Nominators (s)
How to contact you
Date