AOASM Meritorious Student Award Application
Active AOASM student members have the opportunity to be formally recognized for their interest in sports medicine and their contributions to the AOASM organization. Those members who qualify will be considered for the AOASM Meritorious Student Service Award.
Name
*
First Name
Last Name
Email
*
example@example.com
Letter of Support from AOASM Student Chapter Faculty Advisor
*
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Copy of your curriculum vitae (optional)
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Absolute Criteria
AOASM Membership
*
I affirm I am an active member of AOASM.
I am an active member of AOA. My AOA membership number is:
*
You must be a stident in good standing at an osteopathic medical school.
Osteopathic Medical School
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Anticipate date of graduation
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name of your AOASM Student Chapter Faculty Advisor
*
Relative Criteria
You must obtain at least 15 points prior to graduation from medical school using any combination of the criteria below:
Participation on sports medicine team
Sports Medicine Team Participation Evaluation: 1 point per event (maximum 2 points)
Rows
Location
Date
Preceptor
Points
Team 1
Team 2
Mass Participation Event
Mass Participation Event Evaluation: 1 point per event (maximum 2 points)
Rows
Event
Location
Date
Preceptor
Points
Event 1
Event 2
Sports Medicine/Orthopedic Clinic
Sports Medicine/Orthopedic Evaluation: 1 point per 1/2 day in clinic (maximum 2 points)
Rows
Name of Clinic
Date
Preceptor
Points
Event 1
Event 2
Attendance at OMED or Regional Conferences
Attendance at AOASM Sessions or AOASM Regional Conferences: 2 points per event (maximum 8 points)
Rows
Event name
Date
Points
Event 1
Event 2
Event 3
Event 4
Attendance at AOASM Annual Clinical Conference
Attendance at AOASM Clinical Conference: 3 points per event (maximum 12 points)
Rows
Event name
Date
Points
Event 1
Event 2
Event 3
Event 4
Poster Presentation at AOASM Clinical Conference
Poster presentation: 2 points per event (maximum 8 points)
Rows
Title
Location
Date
Points
Presentation 1
Presentation 2
Presentation 3
Presentation 4
Author of published sports medicine topic
Author of electronic or printed scientific manuscript on a sports medicine topic: 3 points per manuscript (maximum 9 points)
Rows
Title
Journal
Date
Points
Manuscript 1
Manuscript 2
Manuscript 3
Please upload copy of each manuscript listed above
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AOASM Student Chapter Officer
Service as a student chapter officer: 2 points per event (maximum 8 points)
Rows
Position/Office
Year
Points
Position 1
Position 2
Position 3
Position 4
Presentation at AOASM Student Chapter meeting (or other formal meeting)
Presentation at AOASM Student Chapter meeting or other formal didactive meeting: 2points per manuscript (maximum 6 points)
Rows
Title
Location
Date
Points
Presentation 1
Presentation 2
Presentation 3
Affirmation
I attest that the information provided is accurate and honest. I realize if an investigation reveals that the information I have supplied is untrue, I may forfeit the AOASM Meritorious Service Award.
*
Submit
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