Welch Memorial Lecturer Entry Form

Welch Memorial Lecture Award

* – indicates a required field.

Personal information of nominee

Nominee's full name *

Address

City

Province

Postal Code

Telephone

Email *

Discipline

Is the nominee a CAMRT member?

Yes

Submitted By

Name *

Member no.

Telephone during the day

Your email *

Do you give CAMRT permission to disclose your name as nominator to the nominee if requested?

Yes

Judging Criteria

Please answer the following questions which are based on established judging criteria for nomination of an individual for the Welch Memorial Lecture. Limit response to each question to 250 words. If possible use examples that are different or expand upon the information provided in the nominee’s CV.

What has been the nominee’s significant contribution that impacted the profession at a national level?

The following are areas where the nominee may have made significant contribution(s) to the profession. It is realized that the nominee may not have contributed in all areas.

How has the nominee influenced the profession in the area of clinical practice?

How has the nominee influenced the profession in the area of education?

How has the nominee influenced the profession in the area of leadership management?

What significant contribution has the nominee made to the profession through research activities?

What contribution has the nominee made to the profession through participating or leading CAMRT activities/committees, representing the profession externally, mentoring, etc.?

How has the nominee enhanced the high standards that are established for the profession?

How is the nominee seen as a leader and a visionary by their peers and colleagues in the field of medical radiation technology through initiatives and taking the lead on projects and/or activities?

What is the strong evidence that suggests the nominee would deliver a presentation worthy of the honor of the Welch Memorial Lecture?

Are there other noteworthy accomplishments by this nominee that should be mentioned? Limit response to 400 words.

If available, also include a copy of the nominee's curriculum vitae (Word or PDF format).

Please wait for confirmation page before clicking “Back” button or closing your browser as this will cancel your upload. If “upload fails” after several attempts please email the files to
Phyllis Williams

Captcha *

reCAPTCHA is required.