Global Emergency Care Research Award

Global Emergency Care Research Award
Form No: FND865
Last Revised: October 2024
Version: v2
This award is open to ACEM Fellows, FACEM Trainees or International Affiliates who have authored an eligible article published during the immediately preceding financial year (1 July to 30 June), when invitations to do so are issued by the College.

As per the ACEM Global Emergency Care Research Policy, each application must be accompanied by a copy of the published article, and the relevant application form signed by the lead author. Where there is more than one author or presenter, the application must confirm that the lead author or presenter has obtained consent from all co-author Fellows, trainees, International Affiliates and research partners to apply for this honour.

Please refer to ACEM Global Emergency Care Research Policy for eligibility and selection criteria and required accompanying documents.
Applicant
Name*

First NameLast Name
ACEM ID*
Email*
example@example.com
Phone Number*

Area CodePhone Number
Address*

Street Address Line 2

CityState / Province

Postal / Zip Code
Date*

DayMonthYear
Date
Eligibility*

I am an ACEM Fellow of good standing with the CollegeI am an ACEM Trainee of good standing with the CollegeI am an ACEM International Affiliate of good standing with the College

Submission
I/We, the [member/s] [trainee/s] listed below, submit the following paper for consideration of the Global Emergency Care Research Award. It is understood that, if successful, it is the paper that receives the award and that the lead author (as stated below) will be invited to accept the award at the annual College Ceremony.
ACEM is accepting applications for both 2023 and 2024. Please specify the year for which you are submitting your application:*

2023 Global Emergency Care Research Award2024 Global Emergency Care Research Award
Title of paper*
Journal title*
Volume and date of publication*
Name of lead author*
Please upload a copy of your published research article*

Cancelof
Name and signature of all co-authors
Co-author 1 name

First NameLast Name
Co-author 1 email
example@example.com
I have obtained consent from this co-author to apply for this honour
Co-author 2 name

First NameLast Name
Co-author 2 email
example@example.com
I have obtained consent from this co-author to apply for this honour
Co-author 3 name

First NameLast Name
Co-author 3 email
example@example.com
I have obtained consent from this co-author to apply for this honour
Co-author 4 name

First NameLast Name
Co-author 4 email
example@example.com
I have obtained consent from this co-author to apply for this honour
Co-author 5 name

First NameLast Name
Co-author 5 email
example@example.com
I have obtained consent from this co-author to apply for this honour
Co-author 6 name

First NameLast Name
Co-author 6 email
example@example.com
I have obtained consent from this co-author to apply for this honour
Declaration
I confirm that I have obtained consent from all author Fellows, trainees, international affiliates and research partners to apply for this honour.
Signature*

Clear
Date*

DayMonthYear
Date

Signature and acknowledgement
Should I be awarded the Global Emergency Care Research Award, I agree that ACEM may use my report, or extracts from my report, for the purposes of publication in ACEM communications and other promotional material.
Signature of applicant*

Clear
Date*

DayMonthYear
Submission process
Applications may be made during the time the applications are open as detailed on the ACEM Website and ACEM Bulletin. No late applications will be accepted.

Applications will be reviewed by the Global Emergency Care Committee and the ACEM Board. Awardees will be notified by email.

Please submit applications via this Jotform by the advertised closing date. Please email honours@acem.org.au if you have any questions.
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Global Emergency Care Research Award

Applicant

Submission

Name and signature of all co-authors

Declaration

Signature and acknowledgement

Submission process