Resident Wellness: Resident Champion Award

Information of the resident being nominated

Name *This question is required.

Program *This question is required.

Training Level *This question is required.

Information of the person submitting this nomination (you)

Name *This question is required.

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

Program *This question is required.

If you are a resident, please indicate your training level

If you are a faculty member, please indicate your position (e.g., program director, department education coordinator)

Nomination Letters

Resident Nomination Letter *This question is required.

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Support letting from Program Director or Department Education Coordinator/Vice-Chair of Education or Chair of Department/Division Head *This question is required.

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Additional Support Letter

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