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Clinician Educator Award

  1. Thank you for your interest in submitting an application for the Clinician Educator Award. Please review the eligibility requirements before submitting your application.

    Application and supporting materials must be submitted by Monday, January 11, 2016 , and notification of awards will be made in February.

  2. First Name(*)
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  3. Surname(*)
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  4. Credentials(*)
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  5. Institution(*)
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  6. Mailing Address(*)
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  7. City(*)
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  8. State/Province
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  9. Zip/Postal Code(*)
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  10. Country(*)
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  11. Phone(*)
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  12. E-mail(*)
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  14. Are you an ASPHO member?(*)


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  16. Curriculum Vitae (.pdf only)(*)
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  18. Project Proposal (.pdf only)(*)
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  19. A document from the applicant of no more than 2 pages divided into the following categories: Specific Aims, Background, Methods and Analysis, Impact and Significance.

  21. Personal Statement (.pdf only)(*)
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  22. A letter from the applicant of no more than one page addressing his/her current qualifications, career goals and a statement describing how the award will benefit his/her career or knowledge base as a clinician educator .

  24. Project Budget with Justification (.pdf only)(*)
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  26. Letter of Support-Supervisor (.pdf only)(*)
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  27. A supporting letter from a supervisor (such as a training program director, program chair, or hospital CEO) or mentor, attesting to the applicant’s status.
  28. Additional Letter of Support (.pdf only)(*)
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  29. (*)

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  30. Your submission will take a minute to upload. You will receive a confirmation once upload is complete.
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  32. Questions or comments? Contact Carissa Van Ausdall.