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CACN Rising Star Award (Trainee / Fellow) Nomination Form
This award honours a Canadian pediatric neurology resident or fellow who has demonstrated exceptional promise through
research, scholarship, or clinical excellence during their training.
Awarded annually
NOMINEE INFORMATION
*
1.
Full name
(Required.)
*
2.
Position/Title
(Required.)
*
3.
Institution/practice
(Required.)
*
4.
City and Province
(Required.)
*
5.
Email
(Required.)
NOMINATOR INFORMATION
*
6.
Nominators
(Required.)
Nominator 1 full name
Nominator 1 email
Nominator 1 relationship to nominee
Nominator 2 full name
Nominator 2 email
Nominator 2 relationship to nominee
*
7.
Confirmation of eligibility
(Required.)
The nominee is a current resident or fellow in pediatric neurology (or has not yet started independent practice as a
pediatric neurologist).
*
8.
Confirmation of criteria met
Check all that apply.
(Required.)
High-quality research output (e.g., top-ranked abstract, publication, or national presentation)
Evidence of academic initiative (e.g., leading projects, securing awards or funding)
Strong letters of support highlighting originality, work ethic, and future potential
Work presented at the CNSF Congress or equivalent national forum (preferred)
*
9.
Nomination statement
Summarize why this nominee deserves the award (maximum 250 words)
(Required.)
*
10.
Upload the nominee's current CV
(Required.)
Choose File
No file chosen
11.
Upload an additional brief letter of support (if available)
Choose File
No file chosen
*
12.
Upload an abstract, manuscript, or other evidence of scholarly output
(Required.)
Choose File
No file chosen
*
13.
Submission
(Required.)
Nominator 1 signature (type full name)
Nominator 2 signature (type full name)
Date
