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WMAA Awards Nomination
WMAA Awards Nomination
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Nominator Information
Full Name
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First
Middle
Last
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Email
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I'm nominating this candidate for the:
Early Career Achievement Award
Emeritus Faculty Award
Honorary Life Membership Award
Medical Alumni Citation – Distinguished Alumni Award
Medical Alumni Service Award
Ralph Hawley Distinguished Community Service Award
Resident/Fellow Citation - Distinguished Resident Award
The
Medical Alumni Citation – Distinguished Alumni Award
honors a medical school alumnus who has achieved distinction in medicine. Achievement is recognized through excellence in the practice of medicine, in academic activities and in research accomplishment. The award will be made at the annual WMAA Awards Banquet only to individuals who are able to personally attend the ceremony.
The
Resident/Fellow Citation – Distinguished Resident Award
honors an individual who has completed a residency or fellowship at the University of Wisconsin Hospital and Clinics and has achieved distinction in medicine. Achievement is recognized through excellence in the practice of medicine, in academic activities and in research accomplishment. The award will be made at the annual WMAA Awards Banquet only to individuals who are able to personally attend the ceremony.
The
Early Career Achievement Award
honors a UW School of Medicine and Public Health MD alumna/alumnus who has attained exemplary success early in their career. They will have made outstanding contributions through clinical service, research, education and/or administrative leadership. An alumnus/a may receive the award no longer than 20 years following their graduation year from UW SMPH.
The
Emeritus Faculty Award
recognizes outstanding service to the UW School of Medicine and Public Health. It is awarded to an emeritus faculty in the Basic and Clinical Sciences who has exhibited exceptional commitment to the school over a period of years.
The
Ralph Hawley Distinguished Community Service Award
is conferred on a UW School of Medicine and Public Health MD graduate who has made outstanding contributions to his/her local community through medical practice, teaching, research, or humanitarian activities.
The
Medical Alumni Service Award
honors a UW School of Medicine and Public Health MD graduate who has made an exceptional commitment to the Wisconsin Medical Alumni Association over a period of years.
The
Honorary Life Membership Award
honors an individual who has been particularly supportive of and helpful to students and alumni. This award is given to a non-alumnus, typically a staff member in the SMPH or the WFAA.
Nominees will be considered for 5 years post nomination date. After 5 years, resubmission is required for future consideration.
Type of Science for Emeritus Award
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Basic Sciences
Clinical Sciences
Letter of Nomination (as PDF)
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Accepted file types: pdf, Max. file size: 2 MB.
Candidate Information
Full Name
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First
Middle
Last
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CV/Resume (as PDF)
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Accepted file types: pdf, Max. file size: 2 MB.
Current Position/Title
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Former Position/Title
UW Hospitals and Clinics GME Position(s)
Residency
Fellowship
Year of Residency Graduation
Year of Fellowship Graduation
Specialty
Year MD Completed
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YYYY
Year MD Completed (if applicable)
YYYY
Summary of Distinctions Achieved in Medicine
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Explain why this candidate is qualified
Summary of Accomplishments
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In areas of teaching and/or research or noteworthy administration, including program development
Special Achievements by Candidate in 3 Categories of Accomplishments Being Reviewed by the WMAA
Practice of Medicine
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Academic Activities Such as Teaching
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Research Contributions
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Contributions to Local Community
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Contributions to UW School of Medicine and Public Health Students and WMAA
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Contributions to WMAA
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Other Qualifications (optional)
This may include descriptions of leadership roles, national awards, recognitions, and honors
I understand that, by submitting this form, my information may be used by WMAA to contact me for additional information regarding this nomination.
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I agree
Phone
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