ASGE Honorary Awards Nomination Form

Nomination Being Made By:

First name

Last Name

Organization

MOBILE Phone

Nominee Information (one nominee per form):

First Name

Last Name

Organization

City

State

Zip/Postal Code

Country

MOBILE Phone

Indicate the award(s) this nomination is for (choose one)

Rudolf Schindler Award

Distinguished Educator Award

Distinguished Service Award

Master Endoscopist Award

Distinguished Endoscopic Research Mentoring Award

International Service Award

Industry Service Award

Required Materials

To nominate yourself or another member for an ASGE Honorary
Award, please upload ALL of the following required materials below (incomplete
nominations may not be eligible for consideration):

Nominee’s Curriculum Vitae or resume
Primary nominating letter describing the nominee’s
accomplishments and a summary of relevant activities,
ensuring the nominee meets awards criteria
One additional supporting letter from a colleague who can
address the longitudinal contributions of the nominee (Rudolf Schindler Award nominations require an additional supporting letter – one nomination letter and two supporting letters total)

Nominee’s Curriculum Vitae

No more than 4 pages (PDF or DOC)

Primary nominating letter describing the nominee’s accomplishments and a summary of relevant activities, ensuring the nominee meets awards criteria

One additional supporting letter from a colleague who can address the longitudinal contributions of the nominee (Rudolf Schindler Award nominations require two additional supporting letters)

Additional supporting letter

Required for the Rudolf Schindler Award

If you have any questions or need additional information, please contact James Janssen at 630.570.5620 or jjanssen@asge.org.