Excellence in Teaching Nomination Form
Name of nominee: _____________________________________________________________
Name of primary Nominator: _______________________________________
Primary nominator’s phone number: __________________________________
Primary nominator’s e-mail address: __________________________________
Circle type of student:
- Medical student
- Biomedical sciences (BIMS) PhD candidate
- MPH candidate
(These individuals may be contacted by the Awards Committee as part of the evaluation process.)
Please return this form with the following attachments:
- Primary nominating letter from a student: a medical student, a biomedical sciences (BIMS) PhD candidate, or a MPH candidate (1 page)
- Executive summary from a faculty member familiar with the nominee’s teaching/mentoring (it is recommended that the primary nominating party contact a faculty member who is familiar with the nominee’s teaching activities). This summary should describe the nominee’s teaching/mentoring activities, and include supporting evidence of the nominee’s educational excellence and worthiness for the award (1page limit).
- Up to 3 additional letters/testimonials from students (medical students, biomedical sciences (BIMS) PhD candidates, or MPH candidates) and/or trainees (postdoctoral fellows) (1 page limit per letter)
- A statement from the nominee’s department chair or division chief that attests to the nominee’s exemplary demonstration of the UVA Health System’s ASPIRE values
- An updated curriculum vitae.
- Relevant portions of the teaching portfolio (optional).
Deliver one electronic copy to Ashley Ayers, as a PDF.