NOMINATION SUBMISSION

This award allows physicians in SIPPA to recognize individuals, teams, or organizations who they have worked with in their assigned communities who have positively impacted their experience. This award also celebrates those who embody the College of Medicine values of accountability, belonging, collaboration, curiosity, and/or well-being.

🟧 Note: Self-nominations are not accepted. Please do not submit any additional materials - they will be removed from the nomination package prior to adjudication.

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* 1. Nominator Information

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* 2. Nominee Information

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* 3. Do you consent to this nomination package being shared with the nominee, whether or not they are the award recipient?

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* 4. Do you consent to being publicly acknowledged if your nominee is the successful recipient?

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* 5. Upload the Nomination Letter, which must be signed by a physician in SIPPA:

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