Superhero of Medicine Award

Superhero of Medicine Award

The Superhero of Medicine Award shall be awarded to a Wisconsin physician who lives out the mission of the Foundation to an exemplary degree, going above and beyond to improve the health of their patients and/or community.
Please use the form below to tell us about a physician you think is deserving of this award.

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 involved in a program of the Foundation or a project supported by the Foundation through a grant or other partnership.
4. Previous winners of the award are not eligible.
Additional letters of recommendation are encouraged. These may be from physicians, patients, community leaders, etc. that help demonstrate the nominee's activities and values. Additional letters of support can be uploaded with the application or emailed to elizabeth.ringle@wismed.org.
Nominee information:
Name *

First Name Last Name Suffix
Clinic/hospital name *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
What do you consider their super power? (What have they done to be considered a hero?) *
Who or what is this hero’s nemesis? (What change in the status quo are they working to make and why does it matter?) *
Provide specific examples of deeds or actions that make this person a hero and the impact he/she has made. (Feel free to also include information on the nominee’s background and character.) *
Does the nominee know that they are being nominated? *

Yes No
Nomination made by:
Name *

First Name Last Name Suffix
Clinic/hospital name *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Relationship to nominee *
Phone Number *

Area Code Phone Number
Email *

Confirmation Email A 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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Superhero of Medicine Award

Nominee information:

Nomination made by: