2020 HIVMA Research Award Nomination Form

The Research Award recognizes HIVMA members who have made outstanding contributions to HIV medicine in clinical or basic research. Nominees must actively be engaged in HIV research and must be junior to mid-career, such as an associate professor or its equivalent for an institution without a formal academic rank. The award will be based on innovation and originality and require demonstration of significant independent research (such as success in securing independent peer-reviewed grant funding) and productivity (such as publications in peer-reviewed journals).

Nominations for the 2020 HIVMA Leadership Awards are due August 7th. Nominators and nominees must be members of HIVMA.

Question Title

* 1. Nominator General Information

Title

First Name

Last Name

Organization

Relationship to Nominee

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* 2. Nominator Type

One seconding nomination from an HIVMA member other than the nominee is required. Standing HIVMA Board and Award Committee members are not eligible.

If you are the primary nominator, please enter the full name and email of the secondary nominator below.

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* 3. Nominator Contact Information

Street Address

Address Line 2

City

State

Zip

Phone

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* 4. Nominee General Information

Title

First Name

Last Name

Organization

Question Title

* 5. Upload Nominee CV

CV should include research, grant awards, and bibliography.

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

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2020 HIVMA Research Award Nomination Form

Question Title

* 1. Nominator General Information

Question Title

* 2. Nominator Type

One seconding nomination from an HIVMA member other than the nominee is required. Standing HIVMA Board and Award Committee members are not eligible.

Question Title

* 3. Nominator Contact Information

Question Title

* 4. Nominee General Information

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* 5. Upload Nominee CV

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* 6. Please discuss how the nominee has demonstrated independent research (as evidenced by ability to obtain grant funding).

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* 7. Please discuss the nominee's level of research productivity (as evidenced in publications in peer-reviewed journals).

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* 8. Please discuss how the nominee has demonstrated innovation and originality through their research.

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* 9. Please discuss the nominee's greater impact on the field of HIV research.

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* 10. Please share any additional information to support your nomination that was not addressed above.

Question Title

* 1. Nominator General Information

Question Title

* 2. Nominator TypeOne seconding nomination from an HIVMA member other than the nominee is required. Standing HIVMA Board and Award Committee members are not eligible.

Question Title

* 3. Nominator Contact Information

Question Title

* 4. Nominee General Information

Question Title

* 5. Upload Nominee CV

Question Title

* 6. Please discuss how the nominee has demonstrated independent research (as evidenced by ability to obtain grant funding).

Question Title

* 7. Please discuss the nominee's level of research productivity (as evidenced in publications in peer-reviewed journals).

Question Title

* 8. Please discuss how the nominee has demonstrated innovation and originality through their research.

Question Title

* 9. Please discuss the nominee's greater impact on the field of HIV research.

Question Title

* 10. Please share any additional information to support your nomination that was not addressed above.

* 2. Nominator Type

One seconding nomination from an HIVMA member other than the nominee is required. Standing HIVMA Board and Award Committee members are not eligible.