Quality Assurance Awards

Name of program director who is submitting this nomination (you)

Name *This question is required.

Program *This question is required.

Email *This question is required. This question requires a valid email address.

Name of resident who is being nominated

Name *This question is required.

Program *This question is required.

Training Level *This question is required.

Nomination Letter (no CVs)

The nomination should summarize the work done and provide sufficient detail to describe the purpose of the project, methodology used, results obtained, and a discussion on the impact of this work. The submission must include a completed abstract or paper in publishable format. When work is done with a supervisor, it is important to describe the initiative shown by the resident and the proportion of the work done by the resident. Supervisor and program director to submit cover letter describing amount of work done and seniority of resident(s).

Nomination Letter *This question is required.

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Paper in publishable format *This question is required.

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Covering letter from supervisor or program director that describes the amount of work done and the seniority of the resident *This question is required.

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If the study required a survey or a workflow diagram was created, you may add it here

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Any additional information about the project, study, or scope of work that may be beneficial to the reviewers can be added here