OA 2025-Mentor-Supervisor-Application form

KBHN Annual Outstanding Awards 2024-2025 Outstanding KBHN Mentor/Supervisor Award

Nomination Form
Nominee Information
Name*

First NameLast Name
Email*
Phone Number*
Position/Role:*
Institution/Organization:*
Nominator Information
Name*

First NameLast Name
Position/Role*
Organization/Institution*
Email*
Phone Number*
Nomination Details
1. Describe the nominee’s mentorship or supervision contributions (max 250 words). Provide specific examples of the nominee’s role in supporting trainees, including how they have inspired, coached, or created a positive learning environment within KBHN.*
2. What impact has the nominee had on trainees or the KBHN training program? (max 250 words). Include measurable outcomes, recognitions, or testimonials that showcase the nominee’s influence and impact on trainees or the program.*
3. Why do you believe this nominee should receive the KBHN Outstanding Mentor/Supervisor Award for 2024? (max 250 words). Share additional details highlighting the nominee’s dedication, creativity, and commitment to KBHN’s mission in mentoring and supervising trainees.*
Supporting Documents
Please attach up to three supporting documents, such as letters of recommendation, testimonials from mentees, or summaries of mentoring activities demonstrating the nominee’s contributions. At least one support letter is required.
Attached Document 1*

Cancelof
Attached Document 2

Cancelof
Attached Document 3

Cancelof
Others
How did you hear about this call?*

KBHN NewsletterSocial Media (e.g.,Twitter, Facebook, LinkedIn, Instagram)Other
If you have selected "Other", please specify
Agreement and Signature

By submitting this nomination, you agree that all information provided is accurate and that the nominee has agreed to be considered for this award.
Nominator’s Signature*

Clear
Date*

MonthDayYear
Should be Empty:

KBHN Annual Outstanding Awards 2024-2025 Outstanding KBHN Mentor/Supervisor Award

Nominee Information

Nominator Information

Nomination Details

Supporting Documents

Others

Agreement and Signature