Javascript is required to load this page.
Page Loaded
ACCOLADES
Name of person or team/unit you are reporting about (if don't know full name, enter role and shift in the name space—e.g. night charge nurse on South Unit)
Last Name
First Name
Team/Unit
Role in Institution of the person receiving accolades
Faculty
Resident/Clinical Fellow
Postdoctoral Fellow
Student
Staff
Other (please describe)
Please note the location of the experience you are reporting
BJH
SLCH
WUSM classroom
WUSM laboratory space
Outpatient clinic
Other (please describe)
Department of the person receiving accolades
Please enter a date for the experience you are reporting (optional, if using, enter date as mm/dd/yyyy)
Date
Positive Experience Report (select all that apply)
Treats others with dignity and respect
Demonstrates exemplary collaboration
Creates an environment that values diversity, equity and inclusion
Demonstrates concern for student/trainee wellness
Outstanding mentor
Outstanding scientist
Outstanding clinician
Outstanding educator
Outstanding administrator
Description of Positive Experience (please do not include protected health information)
Your Name (optional)
NOTE: If you share your name this will be included to the recipient of the accolade when it is shared. To ensure the integrity of assessments, student names will not be shared.
Your Email (optional)
Your Role
Faculty
Resident/Clinical Fellow
Postdoctoral Fellow
MD/MSTP Student
Other Professional Degree Student
Staff
Other (please describe)
Would you like to nominate this person for a teaching award?
Yes
No
Which Phase of the Gateway curriculum is this teaching nomination in regard to?
Phase 1
Phase 2
Phase 3
We encourage you to provide additional specific information about why you are nominating this person for an award:
Powered by Qualtrics