Basmajian Award Nomination Form

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Basmajian Award
Nomination Form

Deadline: October 15, 2007

Saturday, July 19, 2008

To nominate an individual for the Basmajian Award, complete this form and submit it with the supporting materials described below. Only completed nominations received by the deadline will be considered. Only AAA members may submit a nomination; however, the proposed award recipient need not be an AAA member. All successfully submitted nominations may be considered for three years.

Fields marked with a * are required.

Award	Basmajian Award

Please complete the following information about yourself (nominator) Thank you for your interest in AAA’s awards program. Only AAA members may submit an application for the award application that you have selected. If you are a member, log in to the members only section and all of your contact information that AAA has on file will be populated on the form. If after logging in you are not immediately redirected back to this page, use your browser's back button and refresh. If you are not a current member, you may join AAA online or call the main office at 301-634-7910.
Are you currently a member of AAA?*	Yes No
First Name *
Middle Initial
Last Name *
Title *
Company/University *
Address 1 *
Address 2
City *
State/Country *	/
Zip/Postal Code *
Phone *
Fax
Email *

Please complete the following information about the nominee
Nominee's First Name *
Nominee's Middle Initial
Nominee's Last Name *
Title *
Company/University
Street Address 1 *
Street Address 2
City *
State/Country *	/
Zip/Postal Code *
Phone *
Fax
Email *
Suggested citation: The nominee is recognized for *

The following materials must be submitted: Be sure that all necessary information is included. Documents required for the Basmajian Award nomination should clearly reflect the nominee's accomplishments in both research and writing.

Detailed letter of recommendation:* Your letter of recommendation must address both the teaching and scholarship accomplishments of the nominee. AAA will ask the candidate to supply two (2) additional letters of recommendation. At least one of the three (3) total letters of recommendation must be from the nominee's chair, chief, or dean (supervisor) and must document the quality of the nominee's contributions to the teaching of gross anatomy. Letter of recommendation: *
Candidate's curriculum vitae* (NIH biosketch format preferred) documenting:
Research - CV must reflect the nominee's research portfolio, including publications, textbooks, patents, abstracts, chapters, and proceedings papers.
Teaching - CV must reflect the nominee's teaching portfolio, such as experience, awards, and publications on teaching anatomy to students (i.e., undergraduate, graduate, postdoctoral, medical, or residents).
Service - include departmental, school, university, journal, and society level service. Copies of letters documenting good performance in such service are helpful.
Nominee's curriculum vitae (NIH biosketch format):*


Submit this form with supporting materials by October 15, 2007.
AAA will then ask the nominee to submit additional materials by December 1, 2007.
Only completed nominations received by these deadlines will be considered.

American Association of Anatomists
9650 Rockville Pike Bethesda, Maryland 20814-3998
Tel: 301-634-7910 Fax: 301-634-7965 exec@anatomy.org
©2005 American Association of Anatomists