CUA Award of Excellence in Education | Canadian Urological Association

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Please select which award pertains to your nomination

Resident

Pertains to a Canadian Urology Resident

Active Member

Pertains to a practicing Canadian Urologist

Your name (as the nominator)

Name of your institution

Your contact email

Name of nominee

Name of nominee's institution

Nominee’s position at the institution

Nominee's email

Nominee's phone

Nominee's city/town

Nominee's province

Please briefly provide examples/evidence that support the nominee's application based on the following criteria. (Not all fields are mandatory. Select the most applicable fields.)

1) Exemplary teaching contributions at the undergraduate, postgraduate, continuing professional development or graduate levels

2) Contributions to course and curriculum development, implementation and evaluation

3) Development of educational innovations, including new educational technologies

4) Contributions to educational scholarship

5) Demonstration of leadership in education

If possible and applicable, please provide teaching evaluations/comments (up to a maximum of 3 years).

Unlimited number of files can be uploaded to this field.
2 GB limit.
Allowed types: pdf, doc, docx, ppt, pptx, xls, xlsx.

Please provide a letter of support from a program director (resident) or department chair (active member).

One file only.
2 GB limit.
Allowed types: pdf, doc, docx.

Please upload up to 2 letters of reference highlighting criteria.

One file only.
2 GB limit.
Allowed types: pdf, doc, docx.

Please provide one of the following

Nominee's CV

Description of professional credentials

One file only.
2 GB limit.
Allowed types: pdf, doc, docx.

The nominee is aware of this nomination

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