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  1. 1. AWARDS FOR YOUNG INVESTIGATORS IN DERMATOLOGY 2008 Nomination Form Eligible candidates include individuals currently in accredited dermatology residency programs or those who have completed their residencies within the previous two years. (Research must be performed during dermatology training.) 1. a. Young Investigator nominee (name, title/degree): b. Nominee’s institution: c. Address of institution: d. Telephone and fax numbers, and e-mail address: 2. a. Nominating individual and institution (name, academic appointment, title): b. Address: c. Telephone number: 3. Title of research project: 4. Description of research project: Basic research ________ Clinical research _______
  2. 2. 5. Explain briefly (100 words or less) the reason for the investigation and how the project was developed: 6. a. Objectives and purpose of the research (100 words or less): b. Methods used (100 words or less): c. Results derived (100 words or less): d. Conclusions reached (100 words or less):
  3. 3. 7. Describe briefly (100 words or less) how the research project has benefited the specialty of dermatology: 8. Please list any collaborators in this project: 9. a. Was the research funded by any external sources? Yes _________ No _________ b. If yes, by whom?
  4. 4. Completed nomination packet must be received at the American Academy of Dermatology no later than December 3rd. Submit completed nomination form and all attachments to: Department of Education American Academy of Dermatology 930 E. Woodfield Road Schaumburg, IL 60173-4965 Checklist for attachments: (enclose original plus six collated copies of each) 1. A completed nomination form. 2. A two-page, double-spaced narrative description of the nominee’s research, including appropriate reference list. (Summations from the two winners will be published in the Journal of the American Academy of Dermatology.) 3. One letter of recommendation from either the department chair or the faculty advisor. 4. A brochure or brief, one-page description of the residency program. 5. Applicant’s abbreviated CV (not to exceed five pages). Please Note: If external collaborators or sources of external funding represent any perceived or actual conflict of interest with the AAD and its mission, the AAD reserves the right to exclude the nominee from consideration. Candidates should submit the original plus six copies of each form and accompanying materials (one for each judge). Any supplemental materials should relate directly to the questions in this form. None of the materials will be returned unless specifically requested and return postage is provided.