Jerome C. Goldstein Public Service Award

American Academy of Otolaryngology—Head and Neck Surgery Foundation

Call for Nominations

The following information is provided by the AAO-HNSF Executive Committee to guide preparation of nominations for this annual award.

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1. Please submit nominee’s name and curriculum vitae or resume (Please see that your nominee gives detailed information).

2. Sponsor’s statement: In the light of the criteria for the selection process, please give as much information as possible to tell the Selection Committee of your nominee’s background and work. Specifically, tell in detail those special projects and activities that you think make this individual uniquely worthy of this distinguished award.

3. Procure letters of support from the following:

·  Professional organizations served

·  Public organizations served

·  Project or program leader addressing nominee’s involvement in the improvement of patient welfare

4. The nominee’s sponsor should try to gather as much information as possible and give the Selection Committee a reasonable analysis of the energy and professional time given by the nominee towards the improvement of patient welfare.

5. List long-term ongoing related activities in which the nominee is involved.

6. Items 1-5 above must be included with the nominee form.

Please submit a completed nominee form no later than March 1, 2017 by email to Estella Laguna, Director, Governance, at Questions? Call 1-703-535-3693.

Selection Criteria

The Jerome C. Goldstein Public Service Award recognizes members for commitment and achievement in service, within the United States, either to the public or to other organizations, when such service promises to improve patient welfare. This recognizes domestic service only.

This exceptional award shall be presented to any member in good standing of the American Academy of Otolaryngology—Head and Neck Surgery who has most, if not all, of the following credentials:

I. Character

This individual is widely recognized for a consistent, stable character distinguished by honesty, integrity and devotion to the improvement of patient welfare. The individual is recognized as an outstanding example and model to emulate within and outside of the medical community.

II. Profession

This individual is well known for professional excellence and will have demonstrated professional dedication towards the improvement of patient welfare without the desire for personal gain or recognition.

III. Time in life

This individual will have used in a planned and devoted manner a large portion of important individual time in the promotion and/or service in the promise to improve patient welfare.

IV. Pre-eminent by election among peers

Observing the above highly desirable credentials, this individual will be nominated and chosen from among all members of this Academy as the one person who pre-eminently deserves this distinction given by the American Academy of Otolaryngology—Head and Neck Surgery Foundation.

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