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The University of Texas Medical Branch
School of Medicine Alumni Association
Ashbel Smith Distinguished Alumnus Award
NOMINATION FORM
The Ashbel Smith Distinguished Alumnus Award is the highest alumni honor
bestowed by the university’s School of Medicine Alumni Association. The award,
recognizing outstanding service to the medical profession and to humanity honors
the memory of Dr. Ashbel Smith. A prominent figure in Texas medicine, politics
and education, Smith was considered the driving force behind establishing the
University of Texas at Austin in 1881, and a medical department that would later
be known as UTMB, in Galveston in 1891.
Nomination Criteria:
Distinguished in the medical profession
Demonstrates integrity, stature and abilities that will inspire students
and other alumni
Has made important contributions to his or her community
Has made contributions to medical education as a scholar and teacher
Demonstrates pride in the University of Texas Medical Branch and whose
loyalty and interest are evident
Name of Nominee
______________________________________________________________________________
Title
_________________________________________________________________________________________
Address
______________________________________________________________________________________
City/State/Zip__________________________________________________________________________________
Telephone/Fax/Email
___________________________________________________________________________
Is the nominee aware of this nomination? Yes
No
Please attach a statement supporting your nomination of this individual for the
award indicated. Your nomination should not exceed two pages (double-spaced),
and may include up to five attachments from others to support the nomination.
Support documents also should be limited to two pages. Nominations and support
documents should describe how the individual meets the criteria for the award.
Please use specific examples to demonstrate how the individual meets or exceeds
the criteria. Highlight accomplishments that demonstrate commitment to the
criteria. Please do not include booklets, books, brochures, or similar
documents.
All nominations are requested by September 1, 2005.
Mail or fax or cut, paste and email completed nomination packets to:
Dr. Alan Comer
Executive Director of Alumni Relations and Special Events Services
The University of Texas Medical Branch
301 University Boulevard
Galveston, Texas 77555-1320
FAX: (409) 772-3624
Submitted by
_________________________________________________________________________
Signature/Date
________________________________________________________________________________
Title/Department
_______________________________________________________________________________
Telephone/Fax/Email
___________________________________________________________________________
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