2008 Top Doc Nomination Form

 

Please submit a maximum of 3 nominations no later than Friday, July 11, 2008.

 

E-mail questions to Lisa Mignerey, or contact the Office of Regional Medical Education at 409-747-0269.


 You must click the “SUBMIT” button at the bottom of the page in order to send in your nominations.

 

Nomination Information

 

Name of Preceptor:     

City:     

Number of SOM students in 07-08 academic year:                   

Course(s) for which nominee participated:    

 


Qualifications for Nomination
 

Please provide specific reasons for nominating this physician in the space below, emphasizing the characteristics shown:

  • History of exemplary preceptor evaluations from students.

  • Magnitude of contributions to UTMB student education based on the number of students precepted.

  • Exemplary feedback from AHEC, UTMB staff and faculty regarding the quality of student experiences with the preceptor

  • Involvement of the preceptor in his/her community, especially evidence of volunteer service to benefit the community.

  • Preceptor participation in faculty development activities.

  • The nominee may not be a previous Top Doc award winner within the past 5 years (although he/she may have been nominated previously).

 

 

Submission
Your Name:  
Date: