Basic InformationName* First Last Suffix 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 approach to teaching (their personal philosophy of teaching).*Please describe the nominee's sustained and significant scholarly work in surgical education including: teaching activities, curricular development, evaluation and assessment innovations, research, etc.*Please describe a rewarding relationship the nominee had with a faculty mentee including what they worked on and why it was gratifying.*Additonal InformationPlease list the education leadership and administration roles (eg, program director, skills lab director, etc) that the nominee has or has had within their own institution.*Please list the educational leadership and administration roles (chair or co-chair of a committee, other formal leadership title) the nominee has or has had in any national and international education-related organizations.*Please list the nominee's participation with education journals (as either a peer reviewer or editorial board member).*Please list any recognition by a national society for major accomplishment(s) in education.*Please list any further training in education through courses, faculty development, degree/certificate programs, and educational fellowship programs. Finally, please describe something the nominee learned as a result of their further training in education that has changed the way they teach or impacted educational scholarship.*File uploads:Please upload the nominee's CV.*Accepted file types: pdf, Max. file size: 512 MB.Please upload a letter of nomination by a resident, faculty, education administrator, or anyone else with knowledge of the nominee’s masterful teaching and educational scholarship.*Accepted file types: pdf, Max. file size: 512 MB.Please upload no more than 2 letter(s) of support from leaders in education-related national/international organizations to demonstrate nominee’s impact on surgical education.*Accepted file types: pdf, Max. file size: 512 MB.Please upload no more than 2 letter(s) of support from individuals mentored by nominee*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)*Max. file size: 512 MB.CommentsThis field is for validation purposes and should be left unchanged.
