Anatomical Society Fellowship Proposal Form
Anatomical Society
Proposal for Fellowship
Candidates, proposers & supporters should complete pages 1-4 and then send the form by email direct to the Assistant Secretary;
Section 1
Name of the Proposed Fellow (print):
Address (full postal):
Email:
Date of Election as Member (Full) of the Anatomical Society:
Present and Previous Positions:
1
Anatomical Society Fellowship Proposal Form
Section 2
(Do not exceed 2 pages in any section below [a,b,c], proposals that exceed the page limit will be returned to the applicant and will NOT be assessed)
CASE FOR ELECTION TO FELLOWSHIP:
(This section should contain a detailed and reasoned case for the election of the candidate and detail the candidate’s contribution to two of the three areas below: a) Research, b) Education, c) Service.
a). Research
Record of outputs over career including:
i) Papers in international, peer reviewed journals
ii)Invited or refereed national & international conference contributions
iii) Funding & research grants
iv) Research supervision
v) Examining of research degrees
b). Education
Record of outputs over career including:
i) Undergraduate & Postgraduate teaching & examining
ii) Module/Year/Programme Co-ordination
iii) Positive student & peer reviews
iv) Teaching awards & innovation
v) External Examinerships
c). Service
Record of outputs over career including:
i) Professional service eg. membership of public bodies
ii) Academic or corporate administration
iii) Student support eg. Student services, clubs
iv) Educational outreach
v) National & international committee membership
Anatomical Society Fellowship Proposal Form
Section 3
Nomination authorisation sheet
In compliance with the regulations of the Anatomical Society, we Members of the Anatomical Society confirm that we have proposed:
Name of candidate:
Address of candidate:
asa candidate for election to Fellowship of the Anatomical Society.
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Proposer:Date:
Name:
Address & email :
Seconder:Date:
Name:
Address & email :
Supporter:Date:
Name:
Address & email :
(An email from the assistant secretary will be sent to each member above to confirm support).
Anatomical Society Fellowship Proposal Form
Section 4
SUMMARY OF RECOMMENDATION BY PRIZES & AWARDS COMMITTEE:
(This page is for use by the Prizes &Awards Committee only).
Name of the proposed Fellow:
Member (Full) of the Anatomical Society in good standing for 7 years?
YES / NO
Proposer, Seconder and Supporters are Members of the Anatomical Society and confirm support: YES / NO
Evaluation of Application:
a) Research:
b) Education:
c) Service:
Recommendation to Council - Nominate for Fellowship : YES / NO
Chair,
Prizes & Awards Committee
Date:
1