Distinguished Alumni Nomination Form | College of Medicine – Jacksonville

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 March 13, 2024. Nominations for 2024 are currently open.
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 UF College of Medicine – Jacksonville's 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 Development by emailing Development@jax.ufl.edu or calling 904-244-1090.

Nomination Form

The window for nominations is open from January 8, 2024 to March 13, 2024 by completing the fields below.

Fields marked with * are required.

Nominee Information

These questions are about the physician you are nominating.

Name

Education

Employer

Job Title/Designations

Address

Address 2

City

State

Zip Code

Country

Daytime Phone () -

Email Address

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

Program Name

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

Start Date

End Date

Nominated By

Please describe yourself.

Name

Employer

Job Title

Address

Address 2

City

State

Zip Code

Country

Daytime Phone () -

Email Address

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.

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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