Resident Award 2024

For the 2024 Resident Award, the Resident must be in their final year of education at the time of submission, including graduation in the 2023-2024 academic school year. If they are not in their final year and graduating in the 2023-2024 academic school year, they are not eligible for the award, and they will not be awarded. Furthermore, regardless of other nominations within an institution's department either by the same person or another individual, ASCCP Will only accept one nomination per department per institution.

Question Title

* 1. Contact Information of Nominator (Residency Director/Dept. Chair, etc).
Note: The Nominator MUST be an Active ASCCP Member at the time of submission; there are NO exceptions:

First Name

Last Name

Institution

Department

Email Address

Question Title

* 2. What are the Nominators Credentials? (i.e. MD, PhD, NP, etc.)

Question Title

* 3. Contact Information for Resident You are Nominating.

Note: Only (1) Resident per institution may be nominated per academic calendar year.

First Name

Last Name

Email Address

Question Title

* 4. Is the Resident is going into their last year of Residency and graduating in the 2023-2024 academic year?

Yes

Question Title

* 5. What are the Residents Credentials? (ex. MD, WHNP, DO, etc)

Question Title

* 6. If you are submitting this nomination on behalf of an ASCCP Member, but prefer for communication to be sent to you, please enter your contact information below.

Name

Email Address

Resident Award 2024

Question Title

* 1. Contact Information of Nominator (Residency Director/Dept. Chair, etc).Note: The Nominator MUST be an Active ASCCP Member at the time of submission; there are NO exceptions:

Question Title

* 2. What are the Nominators Credentials? (i.e. MD, PhD, NP, etc.)

Question Title

* 3. Contact Information for Resident You are Nominating.Note: Only (1) Resident per institution may be nominated per academic calendar year.

Question Title

* 4. Is the Resident is going into their last year of Residency and graduating in the 2023-2024 academic year?

Question Title

* 5. What are the Residents Credentials? (ex. MD, WHNP, DO, etc)

Question Title

* 6. If you are submitting this nomination on behalf of an ASCCP Member, but prefer for communication to be sent to you, please enter your contact information below.

Question Title

* 7. Brief Description Explaining Why You ﻿are Nominating this Resident:

* 1. Contact Information of Nominator (Residency Director/Dept. Chair, etc).
Note: The Nominator MUST be an Active ASCCP Member at the time of submission; there are NO exceptions:

* 3. Contact Information for Resident You are Nominating.

Note: Only (1) Resident per institution may be nominated per academic calendar year.

* 7. Brief Description Explaining Why You are Nominating this Resident: