Distinguished Mid Career Educator Award Application - The Association for Surgical Education

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Company

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I am nominating:*

Myself

A colleague

Basic Information

Your name:*

First Last Suffix

Your degree(s):*

Your title:*

Your institution:*

Your email address:*

Nominee Information

Name of nominee:*

First Last

Nominee's degree(s):*

Nominee's institution:*

Nominee's title:*

Nominee's email address:*

Eligibility

Is the nominee a member of the ASE in good standing?*

Yes

The nominee is not eligible for the award at this time.

Short Essays

Please write about one paragraph on each of the following:

Please describe the nominee's approach to teaching (their personal philosophy of teaching).*

Please describe something the nominee learned as a result of one of the educational development programs (such as the annual Surgical Education Week, Surgeons as Educators, or other programs) that they have attended that has changed the way they teach.*

Please describe the nominee's 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 mentee including what they worked on and why it was gratifying.*

Additional Information

Please list the education leadership roles (eg, program director, skills lab director, etc) that the nominee has or has had within their own institution.*

Please list the educational leadership 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 any education awards or honors that the nominee has received.*