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Dean's Excellence in Leadership Nomination Form


To nominate a state employee for the KUSM-W Dean’s Excellence in Leadership Award, please complete the following required information. All permanent classified and unclassified state employees and all paid faculty are eligible. Members of the Excellence in Leadership review committee are not eligible for nomination.

  • Completion of the nomination form. Two additional pages may be used if needed.
  • Two letters of support from individuals other than the nominator.
  • Questions regarding the nomination process can be directed to Lisa Brommer, Director of Human Resources, 293-2615.

NOMINEE INFORMATION

Name:
Job Title:
Department:
Work Phone:
Email:
Date of Hire:

NOMINATOR'S INFORMATION

Name:
Job Title:
Department:
Work Phone:
Email:

 

Describe how the nominee contributes to KUSM-W’s core value of excellence in leadership by responding to each of the following questions. Please include specific examples.

KUSM-W Mission: We educate students, residents, and physicians through scholarship, patient care, service, and research to improve the health of Kansans.

KUSM-W Vision: To be the premier center for community-focused medical education and scholarship.

KUSM-W Core Values:

  • Excellence in Education
  • Social Responsibility and Community Orientation
  • Excellence in Leadership
  • Continuous Quality Improvement
  • Responsible Stewardship

A. Mission Support

  • How does the nominee help advance the mission and vision of the medical school?

  • How does the nominee exemplify the school's core values?

B. Professional Development

  • How does the nominee exemplify professional growth and commitment to strengths development?

C. Community Involvement

  • How does the nominee contribute to the community?

D. Leadership

  • How does the nominee inspire others to pursue excellence?

  • How does the nominee exemplify effective communication and the ability to build partnerships that benefit the medical school?


Also please email (link below) two letters of support for the nominee. Letters should demonstrate support of core criteria.

Email all nomination materials to:
KUSM-W Excellence in Leadership Committee



 

Last Modified: August 26, 2008