STFM Excellence in Education Award

Nomination Form

I would like to nominate the following STFM member for the 2008 STFM Excellence in Education Award.

Nominee ____________________________________________________

Institution ____________________________________________________

Address _____________________________________________________

City ________________________________________________________

State _________________________________________ Zip ___________

Phone ______________________________ Fax ____________________

E-mail ______________________________________________________

This award recognizes an STFM member for personal excellence in family medicine education, with demonstrated skills in teaching, curriculum development, mentoring, research, or leadership in education at regional or national levels.

Recipients for this award will be honored during during STFM's Annual Spring Conference in Baltimore, MD, April 30 - May 4, 2008.

• The nominee must be an STFM member.
• A statement from the nominator citing the nominee’s accomplishments and activities that warrant consideration for the STFM award
• Up to three additional letters of support from a former student/resident and a colleague at an institution other than the nominee’s home institution, addressing the nominee’s national or regional contribution
• Curriculum vitae of the nominee

By October 1, 2007, send 11 sets of the nomination materials to Traci Nolte, STFM, 11400 Tomahawk Creek Parkway, Ste. 540, Leawood, KS 66211. 800-274-2237, ext. 5420, e-mail: tnolte@stfm.org.

Nominator ___________________________________________________

Institution ____________________________________________________

Address _____________________________________________________

City ________________________________________________________

State _________________________________________ Zip ___________

Phone _____________________________ Fax ______________________

E-mail ______________________________________________________