GW PT Alumni Award Nomination Form

Purpose

The GW PT Alumni Award recognizes outstanding leadership and service of a GW PT alumnus or alumna. Community service, professional achievements and other such accomplishments are considered, but are secondary to varied service to the University and involvement with the PT program post graduation.

Award Criteria

Any alumnus/alumna who embodies the mission and vision of the GW PT Program in their daily life. The recipient will demonstrate this through:

  • distinguished service to the GW DPT Program and/or University
  • excellence in clinical practice
  • research contributions and/or advocacy that advance the profession
  • community service activities

Nominating Candidates

Any person may recommend an alumnus/alumna for the GW PT Alumni Award. The nomination should include the sections outlined in the form as well as a brief summary of the nominee's service to the Program/University, community service activities, and their professional accomplishments.

Presentation of the Award

The GW PT Alumni Award will be presented during the GW PT Awards Ceremony in May. The recipient of the award must be present to accept the award.

Thank you for your interest. The 2018 nomination process is now closed. We will begin our review of 2019 candidates in January 2019.

Nomination Information
* Nominee Name (current)
* Nominee Name
(while in the program)
* Email Address
* Phone
* Address
Suite/Floor
* City
* State
* Zip Code
*GW DPT Graduation Year
Please provide a brief summary of the nominee's accomplishments as they relate to the award criteria

(Maximum characters: 1000)
You have characters left.
* Submitted by (Name):
* Submitted by (Email):
* Submitted by (Phone):
* Submitted by (Address)
Suite/Floor
* City
* State
* Zip Code
I attest that the information provided is a fair and accurate representation of the nominee.
(Electronic Signature)
 

For any questions related to this form, please contact smhsalumni@gwu.edu. You may be contacted to provide additional information pertaining to the nominee.