Faculty of Dentistry Alumni of Influence Award Nomination Form NOMINATION FORM The Faculty of Dentistry Alumni of Influence Award recognizes our diverse alumni and the exceptional ways in which they serve patients, our school, and our communities. Share your story or that of another great alumni! We invite you to complete the nomination form below and join us in celebrating our Dentistry Influencers in Spring 2024. Nomination deadline: Friday November 10, 2023 WHO IS ELIGIBLE? Nominees must be graduates of the Faculty of Dentistry, University of Toronto. Licensed nominees should be in good standing with their provincial dental association and licensing authority. SELECTION CRITERIA Demonstrated significant achievements through contributions to leadership, mentorship, stewardship, student support, and/or research. Advocacy of the Faculty of Dentistry’s mission to attract and educate the very best students and faculty, innovate and accelerate research discoveries, and deliver exceptional patient care. Demonstrated significant achievement in their dental discipline and/or the community of professional dental practice. For more information on the Alumni of Influence Award including the Terms of Reference, CLICK HERE. SECTION A: NOMINATOR INFORMATION First name: "First name" is required. Last name: "Last name" is required. Phone number: "Phone number" is required. Email: Email address: ";Email address" is required. Confirm email: ";Email address:" confirmed text is required. Emails do not match! ";Email address"needs to contain a valid entry. Your password must have each of the above components and be at least 12 characters. Does Not Pass Low Moderate Secure Very Secure Re-type your password. Re-type your email. Please verify your input by typing it again. Passwords do not match! Emails do not match! Inputs do not match! Passwords match! Emails match! Inputs match! Are you a graduate of the Faculty of Dentistry, University of Toronto? Are you a graduate of the Faculty of Dentistry, University of Toronto? YesNo "Are you a graduate of the Faculty of Dentistry, University of Toronto?" is required. If yes, please specify your graduation year and degree program. Section B: NOMINEE INFORMATION First name "First name" is required. Last name "Last name" is required. Phone Email: Email: "Confirm" is required. Confirm "Confirm" confirmed text is required. Inputs do not match! "Confirm"needs to contain a valid entry. Your password must have each of the above components and be at least 12 characters. Does Not Pass Low Moderate Secure Very Secure Re-type your password. Re-type your email. Please verify your input by typing it again. Passwords do not match! Emails do not match! Inputs do not match! Passwords match! Emails match! Inputs match! Please specify the nominee's degree program and graduation year from the Faculty of Dentistry, University of Toronto. "Please specify the nominee's degree program and graduation year from the Faculty of Dentistry, University of Toronto." is required. SECTION C: NOMINATION List the nominee's professional activities, previous awards, and/or distinctions as applicable. "List the nominee's professional activities, previous awards, and/or distinctions as applicable." is required. Please note: supported files are Microsoft Office file types (.Doc, .PDF, etc.) Mac files like .Pages are not supported. Please include a summary articulating why the nominee is deserving of the Faculty of Dentistry Alumni of Influence Award. Ensure you demonstrate the impact the nominee has had on their dental discipline and/or their community and the resulting significance of their achievements. (Word limit: 500) "Please include a summary articulating why the nominee is deserving of the Faculty of Dentistry Alumni of Influence Award. Ensure you demonstrate the impact the nominee has had on their dental discipline and/or their community and the resulting significance of their achievements. (Word limit: 500)" is required. Please include a short biography of the nominee or a copy of the nominee’s curriculum vitae. "Please include a short biography of the nominee or a copy of the nominee’s curriculum vitae." is required. Self-nominees must also include a letter of support substantiating their case for nomination. Incomplete packages will not be considered. COLLECTION AND USE OF NOMINATION INFORMATION The University respects your privacy. The information gathered here is collected and used for the administration of the University’s advancement and administrative activities (including: the dissemination of news about the University and the alumni community; fundraising; and communication of information about student and/or alumni programming including, events, benefits and services) pursuant to the University of Toronto Act 1971. This information may be shared between the divisions of University Advancement. At all times it will be protected in accordance with the Freedom of Information and Protection of Privacy Act. Please Wait...