PI Nomination Form 2023

2023 IFCK PI Award

Please submit nomination by Thursday, August 31, 2023

1. PI Nominee Information
PI Nominee Name*

First NameLast Name
PI Nominee IFCK Site*
PI Nominee Contact Number
Please enter a valid phone number.
PI Nominee Email*
example@example.com

2. Nominator Information
Your Name*

First NameLast Name
Your IFCK Site*
Your Email Address*
Your Contact Number*

Area CodePhone Number

3. Nomination Letters of Support (minimum of 2)
Cancelof
Cancelof
Optional Letter

Cancelof

4. Complete Vita or Resume
Cancelof

5. Superior Scholarly or Creative Accomplishments (within the past 5 years) **publication or presentation samples may be included**
Cancelof
Additional Accomplishments

Cancelof
The submission deadline is THURSDAY, AUGUST 31, 2023

Contact Dawne Gardner at dawne.gardner@cchmc.org or

Steve Rogers at Scrogers@connecticutchildrens.org

with any questions

Thank you for your nomination!
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