Excellence in Teaching Nomination Form

Name of nominee: _____________________________________________________________

Department: _________________________________________________________________

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

References (name/phone/e-mail):

1. ______________________________________________________________________



2. _____________________________________________________________________



3. _____________________________________________________________________



(These individuals may be contacted by the Awards Committee as part of the evaluation process.)

Please return this form with the following attachments:

  1. Primary nominating letter from a student: a medical student, a biomedical sciences (BIMS) PhD candidate, or a MPH candidate (1 page)
  2. 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).
  3. 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)
  4. 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
  5. An updated curriculum vitae.
  6. Relevant portions of the teaching portfolio (optional).

Deliver one electronic copy to Ashley Ayers, as a PDF.