ACNM Best Mentor Award

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* 1. Information about you - the nominator

Full name with professional designations

Email address

Phone number

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* 2. Who are you nominating for the ACNM Best Mentor Award

Nominee's full name with professional designations

Nominee's institution

City/Town

State/Province

Country

Email Address

Phone number

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* 3. The individual is nominated for which Best Mentor Award

Best Clinical Mentor

Best Personal Mentor

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* 4. For Clinical Best Mentor Nomination: please describe how the nominee has served as a dedicated teacher of clinical nuclear medicine to trainees and other colleagues

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* 5. For Clinical Best Mentor: Please describe the nominee's additional contributions to the field of nuclear medicine

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* 6. For Clinical Best Mentor: Please describe the nominee's additional contributions to the ACNM

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* 7. For Personal Best Mentor: Please describe how the nominee has devoted their time to mentoring nuclear medicine professionals developing their productive professional and personal lives

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* 8. For Personal Best Mentor: Please describe the nominee's additional contributions to the field of nuclear medicine

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* 9. For Personal Best Mentor: Please describe the nominee's additional contributions to the ACNM

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* 10. Please upload the CV of the nominee

It is useful for the awards committee to review the CV of the nominee

PDF file types only.

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* 11. If you have additional comments or narrative to support the nomination, please upload that document here

PDF file types only.