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INFORMATION: THE AWARDS EXPLAINED

Download the nomination document here... or complete and submit the following form:

Dr. Patricia Clugston Memoriam Award for Excellence in Teaching for outstanding clinical teaching of Residents for outstanding clinical teaching of Residents.
Award of Merit for outstanding achievements and/or leadership by a Resident that reflect the aims and objectives of the PAR-BC.
Residents' Advocate Award for advocacy on behalf of Residents which serves to contribute significantly to their well-being.

Candidate:
Full Name:
Address Information
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City:
Postal Code:
Contact Information
Email:
Home PH:
Pager / Cell:

Nominator:
Full Name:
Address Information
Street:
City:
Postal Code:
Contact Information
Email:
Home PH:
Pager / Cell:

Seconder:
Full Name:
Address Information
Street:
City:
Postal Code:
Contact Information
Email:
Home PH:
Pager / Cell:

PLEASE PROVIDE THE FOLLOWING INFORMATION:

  • The reasons why you are nominating this individual
  • How long you have known the individual and in what capacity
  • An up-to-date biographical sketch or a résumé of the nominee
  • Any other information that might assist the Education Committee

References - Persons who might support this nomination should be familiar with the nominee. The references will be contacted in confidence.
Reference #1
Full Name:
Street:
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Postal Code:
Email:
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Pager / Cell:
Reference #2
Full Name:
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Email:
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Pager / Cell:
Reference #3
Full Name:
Street:
City:
Postal Code:
Email:
Phone:
Pager / Cell: