AIHC Interprofessional Collaborative Practice Nomination Form

Description: This award recognizes individuals who demonstrate excellence in interprofessional collaborative practice.

Eligibility: AIHC member in good standing for at least the past two years.

Application/Nomination Procedures:

Self and peer nominations are accepted. Nominations are stronger when the nominee is included in the nomination process.
Careful attention should be paid to the selection criteria when compiling the application packet.
Materials should explicitly state the interprofessional nature of the nominee’s work by enumerating the professions involved.

Nomination Materials:

The following should be provided in the application packet consisting of ten pages or less:

Statement/description of nominee’s involvement in interprofessional collaborative practice
Two letters of support from peers or community partners
Evidence of impact (e.g., peer or patient/client testimonials, publication list, outcomes demonstrating impact, project summaries, etc.)

Contact Amber King at amber.king@jefferson.edu with questions

Nominator

Nominator name

Nominator credentials

Nominator email address

Nominator relationship to nominee

Nominee

Nominee's name

Nominee's credentials

Nominee's profession

Nominee's email address

Nominee's institution

Other than the nominee, who at their institution should be informed if they receive the award? What is that person’s contact information?

Has this person been a member of AIHC for the past 2 years or more?

Yes

Unsure

Upload one file that includes the statement of involvement, two letters of support, and evidence of impact. The nomination packet should be 10 pages or less.

Upload requirements