Resident Wellness: Faculty Champion Award

Information of the faculty member being nominated

Name *This question is required.

Program/Specialty *This question is required.

With which campus is this faculty member associated? *This question is required.

Information of the person submitting this nomination (you)

Name *This question is required.

Program/Specialty *This question is required.

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

Nomination Letters

Resident Nomination Letter *This question is required.Maximum of 2 pages, 500 words per page

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Supporting letter 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 (optional)

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