Contact Information for the Nominee
(You may self-nominate or nominate someone else.)

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* 2. Full Name of Nominee (with designations)

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* 3. Institution

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* 4. Title

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* 5. Address 1

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* 6. Address 2

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* 7. City, State  Zip

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* 8. Email:

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* 9. Phone Number:

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* 10. Please upload the nominee’s CV.

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Please upload two nomination letters below (one to two pages each). The letters should highlight the nominee’s accomplishments and explain why the nominee is deserving of the award. The letters can be written by you, a supervisor and/or a colleague.

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* 11. Please upload letter of nomination #1.

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* 12. Please upload letter of nomination #2 (not required for Miller-Sarkin).

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* 13. The Health Care DeliveryTeaching Program, Teaching Junior Faculty, and the Teaching Mid-Career Faculty awards require additional application materials. Please click on the links above to view the additional requirements. Please upload the additional required application materials here.

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Only fill out this section if you are nominating a colleague.

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* 14. Full Name of Nominator if Different from Nominee (with designations):

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* 15. Institution:

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* 16. Title:

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* 17. Address 1:

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* 18. Address 2:

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* 19. CIty, State  Zip

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* 20. Email:

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* 21. Phone Number: 

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