Distinguished Alumni Nomination Form » College of Medicine – Jacksonville » College of Medicine

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, 2026.
Printed forms may be completed and mailed to the Office of Development, 580 West 8th Street, P-20, 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.

Past Honorees

2021: Cheryl B. Iglesia, MD
2021: Robert C. Luten MD
2022: Thomas Chiu, MD
2023: Richard Milani, MD
2024: Saju D. Joy, MD
2025: Khurram B. Tariq, MD

Nomination Form

The window for nominations is open from January 12, 2026 to March 11, 2026 by completing the fields below.

Name(Required)

Education(Required)

Employer(Required)

Job Title/Designations(Required)

Address(Required)

Address 2

City(Required)

State(Required)

Zip Code(Required)

Country(Required)

Phone(Required)

Email Address(Required)

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

Estimated Start Date as a Resident and/or Fellow

Estimated End Date as a Resident and/or Fellow

Nominated By

Please describe yourself.

Name(Required)

Employer(Required)

Job Title(Required)

Address(Required)

Address 2

City(Required)

State(Required)

Zip Code(Required)

Country(Required)

Phone(Required)

Email Address(Required)

Nomination

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 tell us why this nominee is deserving. Please limit word count to 500.(Required)

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.