Basic InformationYour name:* First Last Degree(s) Your title:* Your institution* Your email address:* Nominee InformationPlease enter the information of the person you are nominating below. Name of nominee:* First Last Nominee's institution* Nominee's title* Nominee's email address:* EligibilityHas the nominee completed at least two years of medical school?* Yes No Has the nominee been an author on a peer-reviewed manuscript or curricular project in surgical education?* Yes No Has the nominee held a leadership role in a course or group related to surgery or surgical education?* Yes No Is the nominee planning to do surgical residency (any specialty)?* Yes No The nominee is not eligible for the award at this time.Short EssaysPlease write about one paragraph on each of the following. Why do you think the nominee deserves this award?*How has the nominee demonstrated passion and enthusiasm for surgery and surgical education research?*Additional InformationPlease list the nominee’s peer-reviewed manuscripts related to surgical education.*Please list any education or teaching awards the nominee has received.*Please list the nominee’s education-related activities (e.g., lectures, programs, presentations, curricula, innovations for teaching or assessment, education-related research).*Please list the nominee’s leadership roles in courses or groups related to surgery and surgical education.*File UploadsPlease upload the nominee's CV.*Accepted file types: pdf, Max. file size: 512 MB.Personal Statement*Please upload a personal statement from the nominee about their commitment to education and education research. Max. file size: 512 MB.NameThis field is for validation purposes and should be left unchanged.
