CHS Early Career Award Nomination

Early Career Award Nomination

To be eligible for this award, candidates:

Must be a CHS member.
Must be within their first seven years of their initial university or academic appointment (calculation of eligibility can be adjusted for part-time appointments and leaves of absence).
Must hold an academic or independent research appointment at a Canadian institution.
Must demonstrate substantial or meritorious contributions in teaching, quality improvement and patient safety (QIPS) or research (clinical, basic science or translational).

Two Nominators are required to provide a letter of recommendation. Nominators must be members in good standing of the Canadian Hematology Society (two peers; faculty and /or trainee).

Deadline: October 31, 2022 @ 1600h ET.

1. Nominee Information *This question is required.

First Name
Last Name
Email Address
Tel. # (xxx-xxx-xxxx)
Institution Name
Position
Street Address
City/Town
Postal Code

2. #1 Nominator Contact Information *This question is required.

First Name
Last Name
Email Address
Tel. # (xxx-xxx-xxxx)
Institution Name
Position
Street Address
City/Town
Postal Code

3. #2 Nominator Contact Information *This question is required.

First Name
Last Name
Email Address
Tel. # (xxx-xxx-xxxx)
Institution Name
Position
Street Address
City/Town
Postal Code

4. Eligibility Criteria *This question is required.

Space Cell	YES	NO
Nominee is within their first seven years of their initial university or academic appointment (calculation of eligibility can be adjusted for part-time appointments and leaves of absence)	Nominee is within their first seven years of their initial university or academic appointment (calculation of eligibility can be adjusted for part-time appointments and leaves of absence): YES	Nominee is within their first seven years of their initial university or academic appointment (calculation of eligibility can be adjusted for part-time appointments and leaves of absence): NO
Nominiee holds an academic or independent research appointment at a Canadian institution	Nominiee holds an academic or independent research appointment at a Canadian institution: YES	Nominiee holds an academic or independent research appointment at a Canadian institution: NO
Nominee demonstrates substantial or meritorious contributions in teaching, quality improvement and patient safety (QIPS) or research (clinical, basic science or translational).	Nominee demonstrates substantial or meritorious contributions in teaching, quality improvement and patient safety (QIPS) or research (clinical, basic science or translational). : YES	Nominee demonstrates substantial or meritorious contributions in teaching, quality improvement and patient safety (QIPS) or research (clinical, basic science or translational). : NO

5. Upload a letter of support. Clearly identify category of academic achievement for which the candidate is being nominated. (Allowed types: png, gif, jpg, jpeg, doc, xls, docx, xlsx, pdf, txt, mov, mp3, mp4
Max file size: 500 KB). *This question is required.

File: {{filename}} delete

6. Upload a letter of support from the Division Chief or Department Chair. (Allowed types: png, gif, jpg, jpeg, doc, xls, docx, xlsx, pdf, txt, mov, mp3, mp4
Max file size: 500 KB). *This question is required.

File: {{filename}} delete

7. Additional Comments