AAMI Foundation Laufman-Greatbatch Award

PRO TIPS:

Please fill out the following form carefully and completely, noting all of the required fields.
All email addresses must be in valid xx@xx.xx format.
16 MB limit on all file uploads.
Your nomination is only submitted once you have reached a screen with a green top bar saying “Thank you for taking this survey”.
Files and supplemental materials may be emailed to awards@aami.org.
Please direct any questions or support needs to awards@aami.org.

Nominee Information:

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* 1. Nominee's Name:

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* 2. Title:

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* 3. Company/Affiliation:

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* 4. Mailing Address:

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* 5. Phone Number:

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* 6. Email Address:

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* 7. Group Nominee Information

If this nomination is for a group or team, please attach the information from the previous entry for each member of the group/team.

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Nominator Information:

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* 8. Nominator's Name:

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* 9. Title:

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* 10. Company/Affiliation:

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* 11. Mailing Address:

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* 12. Phone Number:

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* 13. Email Address:

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* 14. Are you affiliated with the nominee? Note yes or no, and if so, describe your affiliation:

Award Criteria: Nominees must meet all of the following:

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* 15. Nominee has made a significant, singular, and global impact on the advancement of patient care or patient safety. Please describe:

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* 16. Nominee made this impact through the advancement, development, enhancement, or creation of a specific medical device, technology, system, or service. Please describe:

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* 17. Nominator Cover Letter:

Upload nominator’s cover letter that provides a rationale statement describing the extent to which a specific project within the nominee’s work history has had a global impact on patient care or patient safety.

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* 18. CV/Resume:

Upload a current CV/Resume for the nominee(s) here.

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* 19. Letter of Recommendation:

Upload a letter of recommendation (from the past year) supporting this nomination from supervisors, colleagues, and industry partners here.

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* 20. 2nd Letter of Recommendation:

Upload an optional additional letter of recommendation (from the past year) supporting this nomination from supervisors, colleagues, and industry partners here.

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* 21. Nominators are encouraged to submit examples and/or supporting documents that highlight additional activities relevant to this award.

Please upload any desired supporting documents here.

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