Which institution are you affiliated with?
Stanford MedicineUniversity of Maryland School of Medicine

Nominator Full Name

Nominator Email Address

Nominator Faculty Position & Department

Nominee Full Name

Nominee Email Address

Nominee Faculty Position & Department

Please upload a nomination letter (as PDF). 1000 words maximum.
(Please begin the file name with nominee’s last name.)

When submitted, the nominee will receive an email notice from info@drlaureaurelianendowment.org with a link to the Nominee Form to upload their files.