Basic InformationName* First Last Degree(s) Your title:* Your Institution:* Email* Name of nominee:* Nominee's institution:* Nominee's title:* Nominee's email address:*Short EssaysPlease write about one paragraph on each of the following:Please describe the nominee's innovative approach to teaching (the nominee's personal philosophy of teaching).*What educational scholarship is the nominee most proud of and why?*Please identify the nominee's educational productivity accomplishments including: teaching activities, curricular development, evaluation and assessment innovations, etc.*Additional InformationPlease list any educational professional development programs that the nominee has attended (workshops, courses, fellowships, certificate/degree programs, etc)*Please list any education/teaching awards or honors that the nominee has received.*Please list the names of the mentees of the nominee and the nature of their relationship with them (how long did the nominee mentor the person, what was the focus of the mentorship provided).*File UploadsPlease upload the nominee’s CV*Accepted file types: pdf, Max. file size: 512 MB.Please upload a letter of nomination by a faculty, education administrator, or anyone else with knowledge of the nominee’s enthusiasm for exemplary teaching and involvement in surgical education.*Accepted file types: pdf, Max. file size: 512 MB.Please upload no more than 2 letter(s) of support from individuals with direct knowledge of the nominee’s surgical education involvement and outstanding teaching. Commentary on role modeling of professional characteristics and accessibility would be appreciated.*Accepted file types: pdf, Max. file size: 512 MB.Please upload documentation of teaching excellence in the form of an aggregate evaluation report (from MedHub, New Innovations, etc) from learners over the past 6 - 12 months. (file upload)*Accepted file types: pdf, Max. file size: 512 MB.EmailThis field is for validation purposes and should be left unchanged.
