cct-mentor-award (Application)

Submitted by kneislercp on

NCI Outstanding Mentor Award Application

 

OMB No.: 0925-0766
Expiration Date: 09/30/2026

Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0766). Do not return the completed form to this address.

 

Secondary Nominator Form

 

You have been selected as a secondary nominator for the following Mentor Award nominee:

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Please complete your information and respond to the mentor questions in the form below.

Primary Nominator

If you are a current postdoctoral fellow, research fellow, or clinical fellow, use this opportunity to nominate your outstanding mentor. The deadline for nominations is September 28, 2025.

 

Nominee Information
Nominee Organization Details
Telephone:
Your Information
Your Organization Details
Telephone:
Secondary Nominator
Organization Details

Questions About the Nominee:

How many years has the nominee been your mentor?
How many staff members does the nominee currently supervise?
How many fellows/trainees has the nominee mentored during his/her tenure at NCI?
How long has the nominee been mentoring at NCI?

Scientific Expertise

Please share some examples of the nominee’s scientific excellence as it relates to their knowledge, accomplishments, quality, integrity, and work ethics; and how they impart to trainees. Word limit 2000 words.

Accessibility

Please share some examples of the nominee’s ability to being available and accessible. Word limit 2000 words.

Communication

Please share some examples of the nominee’s ability to effectively communicate. Word limit 2000 words.

Training Environment

Please share some examples of the nominee's ability to have a positive training environment. Word limit 2000 words.

Visibility

Please share some examples of how the nominee increased your visibility. Word limit 2000 words.

Career Development

Please share examples of the nominee’s ability to foster your career development. Word limit 2000 words.

Encouragement of Mentoring

Please share examples of the nominee’s ability to encourage mentoring experience. Word limit 2000 words.

Other (optional)

Please share if there anything else you think the review committee should know about the nominee (that is not covered in the above criteria), and why you are nominating them.