This is the electronic version of the Nomination Form for the Department of Physical Therapy and Rehabilitation Science Alumni of the Year Award.

To download an electronic copy to be filled out and returned via email or to be printed out and mailed or hand delivered to the PTRS department please right-click on this nomination form link and choose "Save Target As" and save the file to your computer or memory device. Fill out the form and either email it, mail it, or hand deliver according to the instructions on the sheet

This form can either be submitted electronically, by email, by US postal mail, or dropped off at the Department.

• Electronically – this current page, see below
• Email – send downloaded and electronically filled out nomination form file to Terry Heron at theron@som.umaryland.edu.
• US Mail – mark to the attention of Terry Heron at University of Maryland School of Medicine, Department of Physical Therapy and Rehabilitation Science, 100 Penn Street, Room 115-C, Baltimore, Maryland, 21201.
• Dropped off to Department at room 115-C in the Allied Health Building.

Background

The Alumni of the Year is awarded to an individual who is a graduate of the University Of Maryland School of Medicine’s Physical Therapy program to recognize outstanding achievements in the physical therapy profession. The award is based on contributions/achievements in the areas of academics, administration, clinical practice, research, community service, professional associations, and involvement in the Department of Physical Therapy and Rehabilitation Science. Candidates need not excel in every area, and self nominations are also welcome. Optional – please provide a copy of the nominee’s CV or resume to assist the committee during this process. Thank you for helping us recognize our outstanding alumni!!

Nominee:

Graduation Year:

Nominator:

Please provide brief comments in the appropriate categories indicating the reasons for the nomination.

Academics:

Administration:

Clinical Practice:

Research:

Community Service:

Professional Associations:

Awards/Recognitions:

Involvement in the Department of Physical therapy and Rehabilitation Medicine:

Additional comments:

Optional:
Please send an email to Terry Heron at theron@som.umaryland.edu with nominee's CV/resume attached to the email.