2025 Faculty Leadership Award Nomination Form | Association for University Professors of Neurology

2025 Faculty Leadership Award Nomination Form

Institution *
Chair First Name *
Chair Last Name *
Chair Email *
Nominee First Name *
Nominee Last Name *
Nominee Credentials (MD, PhD, DO) *
Nominee Email *
Nominee Leadership Position *

Clear Selection
Please write a brief statement why you are nominating this individual. *
Please upload the nominee's CV *
Please upload the nominee's headshot *
Additional Comments (Optional)



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