2019 Award Nomination Form
The Diane K. Bollman Chapter Advocate Award is presented to a current or recent (within the past 12 months) ACEP chapter executive or chapter staff member who has made a significant contribution to advancing emergency care and the objectives of an ACEP chapter and the College. The award is named after Diane K. Bollman, who served as the executive director of the Michigan College of Emergency Physicians for 25 years and was an honorary member of ACEP. She represents the archetype of chapter executive advocacy and leadership, personally and professionally.
The award features the recipient’s name and the ACEP logo. The recipient’s name is inscribed on a master plaque at ACEP Headquarters.
Any member of a chapter’s Board of Directors may nominate a current or recent chapter executive director or chapter staff member for this award. The nominee must have been active in the chapter in the last 12 months prior to the award nomination and served for a minimum of three years.
The National/Chapter Relations Committee will evaluate all nominations submitted by the deadline. The nominee should have made an outstanding contribution to advancing emergency care and the objectives of an ACEP chapter and the College within the past 12 months and have served the chapter and the College for a minimum of three years. The nominee should serve as a role model for chapter staff and members and whose leadership attributes should include, but are not limited to: commitment, professionalism, advocacy, service, camaraderie, and devotion. Previous recipients of the Honorary Membership Award are not eligible to receive this award and recipients of this award are not eligible for subsequent nomination.
Any member of a chapter’s Board of Directors may nominate a candidate by completing a nomination form. Submit the nomination form, nominee’s curriculum vitae, and up to three letters of support via the online form or by email to Maude Surprenant Hancock, firstname.lastname@example.org. Letters of support are greatly encouraged and are at the discretion of the nominator. Additionally, a nominee should have only one nomination. All entries must be submitted no later than March 1, 2019 for consideration. Receipt of each nomination will be confirmed by email. Please follow up with Maude Surprenant Hancock if you do not receive a confirmation.
The National/Chapter Relations Committee will judge the entries, with its recommendations subject to review by the ACEP Board of Directors. The decision of the Board is final, and the Board reserves the right to make no award if there are no nominees of sufficient merit. The Board may also decide to grant the award to more than one individual. The award will be presented at the Chapter Executives Forum during the annual meeting. The recipient will also be recognized at the annual President’s Awards Gala.