ISHIB2006

Distinguished Researcher/Outstanding Community Service/ Student Health Professional
Deadline: March 31, 2006

NOMINATOR:

Please complete this form in its entirety, front and back, and return to the ISHIB office at 100 Auburn Avenue, NE Suite 401, Atlanta, GA 30303.

Supporting letters (no more than 2) are optional and may be included or sent separately. These documents may also be sent electronically to ishib@ishib.org.

Deadline for completed nomination form and supporting letters is March 31, 2006. Documents received after the nomination deadline and incomplete nominations will not be considered. If you have any additional questions, contact the ISHIB office at 404.880.0343.

CRITERIA:

Distinguisher Researcher

The nominee must have conducted and published research relating to hypertension and related cardiovascular risk factors as they affect ethnic minority populations.
The nominee must hold a doctorate-level degree.
The award is restricted to members of ISHIB. The honoree must be present at ISHIB2006 to receive award.

Outstanding Community Service

The nominee must be a person or group who has made outstanding contributions to the community in relation to bridging the gap of health and life expectancy among ethnic minority populations.
The award is not restricted to members of ISHIB. The honoree must be present at ISHIB2006 to receive award.

Student Health Professional

The nominee must be a student exhibiting exceptional work in the area of research involving hypertension and cardiovascular-related diseases.
The nominee must be a current student and candidate for postgraduate degree.
The award is restricted to members of ISHIB. The honoree must be present at ISHIB2006 to receive award.

Electronic Awards Submission

Award Nomination

	Nominator Information	Nominee Information
Name*:
Degrees:
Title:
Department/Division:
Institution*:
Business Address*:
City*:
State/Province*:
Postal Code*:
Country*:
Telephone*:
Fax:
Email:
Membership Number:

TO BE FILLED OUT FOR ALL AWARDS

Provide concise reasons why nominee should receive the award based on accomplishments and contributions of significance toward reducing ethnic health disparities.

FOR DISTINGUISHED RESEARCHER and STUDENT HEALTH PROFESSIONAL ONLY

List Nominees

Publication/Journals/Books/Dates

FOR COMMUNITY SERVICE ONLY

Describe the type and scope of community service performed by the nominee and how it affects the health of ethnic minority populations.

FOR DISTINGUISHED RESEARCHER and STUDENT HEALTH PROFESSIONAL ONLY

Describe the nominee’s professional and community activities and honors.

FOR DISTINGUISHED RESEARCHER and STUDENT HEALTH PROFESSIONAL ONLY

Identify the nominee’s future research goal as they relate to the health of ethnic minority populations.

Attach CV and/or supporting letters.
Please include a letter describing, in 300 words or less, the most important achievements of the nominee and how you feel the nominee will make future contributions to health care in ethnic minorities. Please also include a complete curriculum vita of the nominee. Nominations may also be submitted electronically. If you have any questions, contact the ISHIB office at 404.880.0343.

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