Application for the Peter C.P. Char Excellence in Education Program Director's Award
This application and supporting documents are due by March 1st.
Name (Nominee)
*
First Name
Last Name
Email (Nominee)
*
example@example.com
Phone Number (Nominee)
Please enter a valid phone number.
Training Program:
*
# of Years as Program Director
*
# of Years Devoted to Career:
Nominator Info
Name (Nominator)
*
First Name
Last Name
Email (Nominator)
*
example@example.com
Phone Number (Nominator)
Please enter a valid phone number.
Letters of Support
# of Letters of Support
Please indicate the name, titles, and affiliation.
I acknowledge that I will email letters of support to adudoit@hawaiiresidency.org by the due date of March 1st.
*
Yes, I confirm and understand.
Evidence of Academic Contribution
Using the information from the nominee's letters of support and curriculum vitae, please complete the following information below. Please complete all answers, and respond with N/A if the question is not applicable to the nominee.
Program/Curriculum (including development and improvement:
*
Leadership/Values/Principles:
*
Role Model/Mentorship
*
Teaching and other awards:
*
Resident/Faculty Development:
*
Patient Care and Safety:
*
National, State, Local Activities Related to Teaching and Education:
*
Member, Program Director's Association: (If yes, please specify name, address, and phone number of association)
*
Books, Chapters, Articles Related to Education:
*
Research and Scholarly Activity in Field:
*
Submit
Should be Empty: