Outstanding Faculty Mentor Award Nomination Form

Description: This annual award is given to an AIHC member for outstanding mentorship to advance interprofessional collaboration. Mentorship may be formal or informal and with students and/or peers. Nominations for this award must come from an AIHC member. Self-nominations are accepted.

Eligibility: AIHC member in good standing for at least the past two years. Preference will be given to individuals who have served as a mentor with the AIHC Mentoring Program.

Nomination Materials:

Nomination letter addressing selection criteria (see below)
CV highlighting interprofessional mentoring engagement

Selection Criteria: The following criteria should be addressed in the nomination letter:

Demonstrates serving as a role model for interprofessional collaboration
Provides interprofessional experiences to students and/or peers to develop and advance understanding of interprofessional collaboration
Encourages participation in interprofessional networking activities
Demonstrates a strong commitment to mentoring such as participating as a mentor with the AIHC Mentoring Program

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

What makes this nominee an outstanding candidate for this award?

Upload one file that includes the nomination letter and CV. The nomination packet should be 10 pages or less.

Upload requirements