SimGHOSTS Simulation Champion Award Nomination Form
Awarded to members of the healthcare simulation technology community in recognition of exemplary performance in their role as a healthcare simulation technology specialist or significant contribution to the field of healthcare simulation technology.
Information collectd in this form is used to assess the suitability of the nominee for the SimGHOSTS Simulation Champion Award. You will need to know some basic information about the person you are nominating to complete the form. This includes their name, position, employer and an email address at which they can be contacted. You will be asked to say why you think the person is deserving of an award and to provide any details of their actions or service that support this that you are aware of. You will also need to supply the details of up to two referees who we may contact in order to get more information about the nominee.
Your full name *
Your answer
Your email address *
Your answer
Nominated individual's full name *
Your answer
Nominated individual's position title *
Your answer
Nominated individual's employer *
Your answer
Nominated individual's email address *
Your answer
Please describe how the nominated individual contributes to the healthcare simulation technology community *
Your answer
Please describe how the nominated individual's performance impacts on educational or patient outcomes
Your answer
Please describe a solution or invention that the nominated individual contributed to
Your answer
Please describe how the nominated individual provides creative/novel solutions to workplace needs
Your answer
Please describe a situation where the nominated individual performed above expectations
Your answer
Describe how the nominated individual's performance serves as an inspiration to others
Your answer
Please add any other relevant information to support your nomination if you are not able to complete responses to all assessment criteria.
Your answer
Please provide name and email/phone contact of up to two referees who may be able to provide additional information about the nominee. *
Your answer
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