2019 GCEP Awards Nomination Form

Award Designation:
Please check one
 GCEP Leadership Award
 Emergency Department Director of the Year
 In-Training Professionalism and Service Award
 
Nominator Information
The completed nomination form and the nominee's curriculum vitae must be submitted electronically preferably in Word format, to Tara Morrison, GCEP Executive Director, at tara@theassociationcompany.com, no later than May 31, 2019 to be considered by the Awards Committee. Up to three letters of support for the nomination may also be submitted. Letters of support are greatly encouraged and are at the discretion of the nominator. The letters of support should explain why the nominee merits the award and specifically relate the nominee's background to the award criteria. Please also submit any letters of support in Word format.

Receipt of each nomination will be confirmed by e-mail. Please follow up with Tara Morrison if you do not receive a confirmation.
 
Nominator
Nominated By:
Telephone:
Email:
Address:
City,State,Zip:
 
Nominee
Nominee Name:
Telephone:
Email:
Address:
City,State,Zip:



Please state why this person should be honored with this award, based on the award criteria:


Offices Held (National and Chapter):

Committees (National or Chapter, and Length of Service):

Other Emergency Medicine-Related Services (Title and Length of Service):

Other Activities of Special Merit (Civic, Institution, etc.):