Nomination Form for the SCCM Ohio Chapter Outstanding Member Award

The Ohio Chapter of SCCM promotes the professional development of members through the provision of the Outstanding Member Award. The award aims to support professional development and to assist our members in achieving personal learning goals, and to promote optimal care of critical care patients in Ohio. Members of the Executive Board are not eligible for this award; however, Committee Chairs and Chair-elects are eligible.  

The award winner will be selected by the Executive Board based on the following criteria: 
- Current member of the Ohio Chapter of SCCM or nominee must join if selected as winner
- Submission of the below application (self-nominations are allowed)
- The nomination should include written examples of how the Ohio Chapter member has demonstrated active participation and engagement in Ohio Chapter activities. Enough information should be provided such that the chapter should be able to understand why the member should be recognized. 
- Submission of CV/Resume 
 
Award: Recipients of the Outstanding Member Award receive a monetary award of $500 to be utilized for supplies/education related to professional development or for attending the SCCM National Congress. This award is intended to offset the expenses of registration, travel, food, and lodging. Costs for leisurely activities and alcohol will not be reimbursed. In order for recipients to be reimbursed, all original receipts must be submitted to the Treasurer of the Ohio Chapter of SCCM. Awardees will be reimbursed only upon submission of itemized receipts. The Awardee will also receive a plaque and be recognized at the annual symposium and on social media. 
A photo of the recipient with the award will be requested for posting on social media. 
 
Submission deadline: October 15th, 2023

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* 1. Name of nominator (First and Last) and credentials

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* 2. Email address of nominator

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* 3. Name of nominee (First and Last) and credentials

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* 4. Email address of nominee

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* 5. Institution of nominee

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* 6. Describe the nominee's current involvement with the Ohio Chapter, SCCM community activities, and any other relevant professional activities.

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* 7. Describe and provide specific examples of how the nominee has positively impacted the SCCM Ohio Chapter. Enough information should be provided such that the chapter can understand why the nominee deserves to be recognized as an outstanding member.

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* 8. Please upload the nominee's CV/Resume.

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