Medical Education Award Nomination Form

Please note: The closing date to submit nominations is January 29, 2022, 17:00hrs EST. Only online submissions will be accepted

Nomination Process

Nominations may be submitted, accompanied by suitable documentation, by any member of Resident Doctors of Canada, Provincial Housestaff Organizations, Departments of Post-Graduate Medical Education, or any other organization associated with RDoC or post-graduate medical education. Serving RDoC Board members and Award Committee members are not eligible to receive an RDoC Award.

Who Are You Nominating?

Select one:*

I am nominating staff (program director, educator, program, or organization) for this award.
I am nominating a resident for this award.

Name of individual/organization being nominated:*

Title/Position (if nominating a resident please include their PGY and specialty):*

Affiliated Faculty of Medicine:*

Address*

Street Address City Province/Territory Postal Code

Telephone Number:*

Email Address:*

Nominator Information

Name of individual/organization submitting nomination:*

Title/Position:*

Affiliated Faculty of Medicine:*

Address*

Street Address City Province/Territory Postal Code

Telephone Number:*

Email Address:*

About the Nominee

In the text box below, outline why RDoC should consider your nominee for this award by highlighting the following (500 words maximum):

Contributions made by the nominee in promoting and advocating for medical education in Canada;
Innovations and creativity demonstrated by the nominee in addressing issues in medical education;
Leadership roles held by the nominee in the medical education community;
Mentorship roles held by the nominee that motivate or develop capacities in others; and
The impact the nominee has made as a specific result of their work.

Description of nominee

Letters of Support

Up to two 1-page letters of support from separate individuals or organizations familiar with the nominee’s activities. Letters must be in 12pt font and in Word or PDF format. Letters may be uploaded with the nomination form or may be emailed to awards@residentdoctors.ca.

Upload Files:

Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 8 MB, Max. files: 2.

Nominee's Curriculum Vitae

A 2-3 page CV outlining related experience.

Upload File*

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Accepted file types: doc, docx, pdf, Max. file size: 8 MB, Max. files: 1.

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