Excellence in Medical Student Teaching Awards Application Form

1. Read the guidelines and FAQs before completing the application. 
2. Eight complete copies of your application must be submitted by November 15, 2003 to: Carol Koenig, Undergraduate Medical Education, Room 109 CMW, M/C 785.
3. All questions may be directed to Carol at (312) 996-9032 or CKoenig@uic.edu

EXCELLENCE IN MEDICAL STUDENT TEACHING AWARDS APPLICATION FORM

Department: __________________________________________________________________

Category:

____General Teaching Excellence:   Basic Science____Clinical____

____Improvement in Quality of Medical Student Teaching:   Basic Science____Clinical____

____Outstanding Achievement in Medical Student Teaching in a Single Course or Clinical Experience