THE DAVID FEAR FELLOWSHIP
NOMINATION FORM
The David Fear Fellowship award supports Continuing Professional Development activities such
as leadership courses, site visits, attendance at meetings, etc.
Candidate Information
Name of Nominee: _____________________________________________________________
Organization: _________________________________________________________________
Position: _____________________________________________________________________
Address: _____________________________________________________________________
Telephone: (
) _______________________ Fax: (
) _______________________________
E-mail: _______________________________________________________________________
Nomination Information
Name of Nomination: ___________________________________________________________
Organization: _________________________________________________________________
Position: _____________________________________________________________________
Address: _____________________________________________________________________
Telephone: (
) _______________________ Fax: (
) _______________________________
E-mail: _______________________________________________________________________
Information Required:
Please provide the following documentation:
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The nominee must indicate, in a 1-2 page letter, his/her interest in continuing education,
and in what ways the expertise acquired by the Fear Fellowship support will be utilized
The letter must be accompanied by one or more letters of support, from departmental
chairs, other faculty members, or from community-based health professionals
Once the professional development activity has occurred, the fellow will report back to a
meeting of the CPD Leaders and Directors Group and/or in another forum, eg. at an
Education Rounds
It is not anticipated that the fellowship award will cover all expenses, and may be
matched by other funds, either personal or departmental
Support for this fellowship will be a maximum of $2,000, available in a one year period,
derived from University of Toronto sponsorship fees and the Academic Development
Fund in Continuing Professional Development
The fellow is obliged to acknowledge the University of Toronto David Fear Fellowship in
relevant presentations, publications, as appropriate
Nominations can be submitted to the foundation, by ________________ in several ways:
 by Fax: (416) 971-2200
 by E-mail: vashty.hawkins@utoronto.ca
 by mail:
Continuing Professional Development, Faculty of Medicine, University of Toronto
500 University Avenue, Suite 650
Toronto, ON M5G 1V7