Please share your accomplishments (individual and/or division based) with the Department of Medicine. This one page survey helps the department to collect all types of accomplishments throughout the year, no matter how big or small. We are looking for awards, appointments, research accomplishments, grants and more!

Submissions are used to help us recognize faculty and staff in the department newsletter and department-wide announcements. The information is also used to help generate lists which are shared with the School Of Medicine and Woodruff Health Sciences Center. They use this information for their quarterly reports as well as internal and external university communications (i.e. Emory Medicine magazine, Health Sciences Update, etc).

Thank you for your time!

* 2. Preferred name of the faculty member being recognized.

* 3. Academic Rank of Faculty Member

* 4. Academic degrees individual holds. (Please select all that apply.)

* 5. Please list all of the individual's credentials. (i.e. FACP, etc.)

* 6. Choose a category for the award, achievement or honor.

* 7. Title of the accomplishment.

* 8. Date awarded and time frame/term for award.

* 9. Organization recognizing accomplishment.

* 10. Please provide additional details on the accomplishment.

* 11. Please list a contact name, phone number and/or email should there be further questions regarding the details of this accomplishment.

Contact Name:

* 12. Phone Number:

* 13. Email: