Distinguished Alumni Nomination Form

The University of Florida College of Medicine – Jacksonville Distinguished Alumni Award is presented to the College of Medicine -Jacksonville residency or fellowship graduate who has achieved extraordinary success in their respective discipline and who has embodied the mission of the College of Medicine -Jacksonville.

Nomination criteria

  • The nominee must be a former resident or fellow who completed their training at the College of Medicine -Jacksonville and has not previously received the award. Nominees may be considered in future years with a new nomination form.
  • The nominee must exhibit accomplishments in one or more of the areas that mirror the mission of the University of Florida College of Medicine – Jacksonville: to heal, to comfort, to educate and to discover through quality health care, elimination of health disparities, medical education, innovation and research.

Nomination Instructions

  • Complete the following form as accurately as possible.
  • Please verify nominee contact information prior to submitting.
  • Nomination forms should be submitted online or via mail by April 19, 2021.
  • Printed forms may be completed and mailed to the Office of Educational Affairs, 655 West Eighth Street, Jacksonville, FL 32209.
  • Honorees will receive a special invitation to be recognized at the annual Celebration of Resident and Fellow Education and Research Day at the downtown Jacksonville campus held annually in June.
  • For questions or additional support, contact The Office of Educational Affairs by calling or emailing Charity Snodgrass at 904-244-3149 | UFJAXGME@jax.ufl.edu.

Nomination Form

Fields marked with * are required.

Nominee Information

These questions are about the physician you are nominating.

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University of Florida College of Medicine – Jacksonville Residency/Fellowship Program:

Estimated Dates as a Resident and/or Fellow at University of Florida College of Medicine – Jacksonville:

Nominated By

Please describe yourself.

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Nomination

Please tell us why this nominee is deserving.

Describe the professional accomplishment(s) of the nominee in one or more of the areas related to the mission of the College of Medicine - Jacksonville: to heal, to comfort, to educate and to discover through quality health care, elimination of health disparities, medical education, innovation and research.

Please limit word count to 500.

Additional Information

Include any additional information that is pertinent about this nominee.

Please limit word count to 250 and avoid simply pasting a resume or CV.

Thank you for your interest and support of the University of Florida College of Medicine – Jacksonville. Please click submit below, and you will receive confirmation of your nomination.


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