Rising Star Award Rising Star Award Nomination Nominator’s First and Last Name, Suffix * Nominator’s Email * Nominator’s Department/Program/School * Nominator’s School of Medicine Affiliation * Faculty Member Course Leader Program Director Department/Program/School Leader Nominee’s First and Last Name, Suffix * Nominee’s Department/Program/School * Nominee’s Title (including level) * Why are you nominating this person? Please provide a brief statement of qualifications, contributions, and impact on education (max. 500 words). * Drop a file here or click to upload Choose File Maximum upload size: 51.2MB Please upload the nominee’s Curriculum Vitae (CV) * Drop a file here or click to upload Choose File Maximum upload size: 51.2MB Please upload the nominee’s Clinician-Educator Portfolio (CEP) or their Summary of Educational Activities * Drop a file here or click to upload Choose File Maximum upload size: 51.2MB Click here for Structured Letter of Support template One structured letter of support (nominator may serve as letter writer) * Drop a file here or click to upload Choose File Maximum upload size: 51.2MB Supplementary documentation: Please upload supplementary documentation if relevant and available. Drop a file here or click to upload Choose File Maximum upload size: 51.2MB If you are human, leave this field blank. This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. Submit Δ