2025-2026 LMSA MW Mentor of the Year Nomination Form
LMSA Midwest is thrilled to honor one individual this year with the LMSA MW Mentor of the Year Award. This award recognizes the contribution of a physician, faculty member, and/or other professional who goes above and beyond in supporting LMSA MW members. We present this award annually at the LMSA regional conference gala -- to this end, please submit your nominations by January 30, 2026. You can nominate as many individuals as you would like.

This form has two pages. On page 1, you will be asked to provide information about yourself, in case it is necessary to contact you for additional information. On page 2, you will be asked to provide additional information about your mentor, including an nomination essay (capped at 500 words).

Nominations will be scored by an MW board evaluation committee using this rubric. Please email mentorship.midwest@lmsa.net with your questions or concerns. We can't wait to hear about your amazing mentors!
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Email *
Nominator (student, mentee)'s name: 
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Nominator's email:
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Nominator's institutional affiliation:
Nominator's year (e.g., M1, G4, etc.):
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