2021 Mentor Award Nominations

Please complete the nomination form below for the Mentor Award.

If you have trouble with the form below, please submit the required nomination information in a single pdf to OHBM Executive Office at info@humanbrainmapping.org by Friday, January 8, 2021.

Full Name: *
Your Institution:
Your Email: *
I would like to nominate (full name): *
Please provide a copy of the nominee's current CV or Biosketch. *
Upload a letter (no longer than a 1,000 words), written by the nominator, summarizing the impact of the nominee on the training/careers of his/her mentees. *
Upload a second letter (no longer than a 1,000 words) written by a primary and a secondary mentee (can be former or current mentees) who can each provide a first-hand account of how the nominee influenced his/her career. Academic, clinical, and educational achievements on the part of the mentee will be considered important. *
Upload a third letter (no longer than a 1,000 words) written by a primary and a secondary mentee (can be former or current mentees) who can each provide a first-hand account of how the nominee influenced his/her career. Academic, clinical, and educational achievements on the part of the mentee will be considered important. *
Upload a fourth letter (no longer than a 1,000 words) written by a primary and a secondary mentee (can be former or current mentees) who can each provide a first-hand account of how the nominee influenced his/her career. Academic, clinical, and educational achievements on the part of the mentee will be considered important. *



Fields marked with * are required.

Your form submission WILL be encrypted using SSL to ensure your privacy.

hbm_logo.png
OHBM MEMBERS
Reset password