2022 HIVMA Research Award Nomination Form

The Research Award recognizes HIVMA members who have made outstanding contributions to HIV medicine in clinical or basic research. Nominees must actively be engaged in HIV research and must be junior to mid-career, such as an associate professor or its equivalent for an institution without a formal academic rank. The award will be based on innovation and originality and require demonstration of significant independent research (such as success in securing independent peer-reviewed grant funding) and productivity (such as publications in peer-reviewed journals).

Primary nominators - please complete questions 1 through 6.

Secondary nominators - please complete questions 1, 2, 3 and 8.

Nominations for the 2022 HIVMA Awards are due Monday, June 6th, 2022. Nominators and nominees must be members of HIVMA.

Question Title

* 1. Nominator General Information

First Name

Last Name

Title

Organization

City

State

Phone

Relationship to Nominee

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* 2. Nominator Type:
A seconding nomination from an HIVMA member other than the nominee will be required. HIVMA staff may be able to help with identifying a seconding nominator. Email HIVMA at info@hivma.org for additional information.

If you are the primary nominator, please enter the full name and email of the secondary nominator below.

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* 3. Nominee General Information

Title

First Name

Last Name

Organization

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* 4. Upload Nominee CV

CV should include research, grant awards, and bibliography.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 5. Please discuss how the nominee has demonstrated independent research (as evidenced by ability to obtain grant funding) and innovation and originality through their research.

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* 6. Please discuss the nominee's level of research productivity (as evidenced in publications in peer-reviewed journals) and greater impact on the field of HIV research.

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* 7. Please share any additional information to support your nomination that was not addressed above.

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* 8. FOR SECONDARY NOMINATORS - please provide a statement of support for the nominee that addresses their research contributions and their impact on the field of HIV research.

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* 1. Nominator General Information

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* 2. Nominator Type:A seconding nomination from an HIVMA member other than the nominee will be required. HIVMA staff may be able to help with identifying a seconding nominator. Email HIVMA at info@hivma.org for additional information.

Question Title

* 3. Nominee General Information

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* 4. Upload Nominee CV

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* 5. Please discuss how the nominee has demonstrated independent research (as evidenced by ability to obtain grant funding) and innovation and originality through their research.

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* 6. Please discuss the nominee's level of research productivity (as evidenced in publications in peer-reviewed journals) and greater impact on the field of HIV research.

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* 7. Please share any additional information to support your nomination that was not addressed above.

Question Title

* 8. FOR SECONDARY NOMINATORS - please provide a statement of support for the nominee that addresses their research contributions and their impact on the field of HIV research.

* 2. Nominator Type:
A seconding nomination from an HIVMA member other than the nominee will be required. HIVMA staff may be able to help with identifying a seconding nominator. Email HIVMA at info@hivma.org for additional information.