2009 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):
c. Telephone number:
3. Title of research project:
4. Description of research project:
Basic research ________ Clinical research _______
AWARDS FOR YOUNG INVESTIGATORS
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):
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?
The completed nomination packet must be received at the American Academy of
Dermatology no later than September 30th
. Submit completed nomination form
and all attachments to:
Department of Science & Research
American Academy of Dermatology
930 E. Woodfield Road
Schaumburg, IL 60173-4965
Checklist for attachments: (enclose original)
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).
Candidates should submit the original copy of each form and accompanying materials.
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
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.