Kenneth M. Viste Jr, MD Young Physician Leadership Award

Kenneth M. Viste Jr, MD Young Physician Leadership Award

The Wisconsin Medical Society and all of the Society’s affiliates lost one our most compassionate and passionate leaders in 2005. At age 64, Dr. Viste remained an active volunteer at local, state and national levels. He exemplified commitment to patients, community and the profession of medicine. The Kenneth M. Viste, Jr., MD, Young Physician Leadership Award was established in 2006 in his honor to recognize a young physician each year who demonstrates these attributes. In addition to an engraved award, the Foundation will make a contribution to a charitable organization selected by the award recipient.
Nominations close November 1.

Please use the form below to tell us about a physician you think is deserving of this honor.

Requirements:
1. The physician must be a Wisconsin resident.
2. The physician must be a medical doctor (MD) or doctor of osteopathy (DO).
3. The physician must be less than 40 years of age or in the first eight years of practice after their residency and fellowship training.
4. Previous winners of the award are not eligible.
5. Nomination must come from a physician representing a medical-related organization such as a county medical society, specialty society, hospital or clinic.
6. Additional letters of recommendation are encouraged. These may be from physicians, patients, community leaders, etc. that help demonstrate the nominee's activities and values that promote Dr. Viste's exceptional legacy. Additional letters of support can be uploaded with the application or emailed to elizabeth.ringle@wismed.org.
Nominee information:
Name*

First NameLast NameSuffix
Clinic/hospital name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Why do you believe the nominee should receive the Kenneth M. Viste, Jr., MD, Young Physician Leadership Award?
Please give some specific examples of the nominee's commitment to patients. (Involvement in research, advocacy, innovative ways to communicate or serve patients, etc.)
Give at least one specific example of the nominee's efforts in their community. (Community projects, public offices, participation in civic, service and charitable organizations, etc.)
Nomination made by:
Name*

First NameLast NameSuffix
Preferred Name
How do you prefer to be address, for example Kate versus Kathryn
Pronouns
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*

Confirmation EmailA copy of your nomination will be sent to this address
If you have additional letters of support or supporting documents, uploaded them here. You can also email documents directly to elizabeth.ringle@wismed.org.

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Kenneth M. Viste Jr, MD Young Physician Leadership Award

Nominee information:

Nomination made by: