Tow Humanism in Medicine Interim Report - Arnold P Gold Foundation

Tow Interim Report

Thank you for recognizing exemplars of humanism through the Tow Humanism in Medicine Awards!

Deadline to submit: March 28, 2025 (or at least 60 days before award ceremony)

Instructions:

To participate, your school must have signed the Tow Award Agreement.
Complete all required fields. We will not be able to issue the full award package until we receive an acceptable biosketch, reflecting the awardee's humanistic qualities, and a headshot, for each recipient.
There is no "save" feature, so please consider gathering all the required information using this downloadable worksheet (Word doc).
In order to complete your form you will need:
- A brief biosketch of each awardee including the awardee’s humanistic qualifications (not a CV or resume)
- A headshot photo of each awardee
Once you submit, you will receive a confirmation email that includes all the completed form fields.

If you have trouble with the form or any questions, contact Stacy Morris at smorris@gold-foundation.org.

PRIMARY CONTACT INFO
School Name *
If different than above, indicate school name as it should appear on certificate:
Agreement 1 *	Our School has reviewed and has adhered to the Tow Procedures and Criteria Document.
Agreement 2 *	I understand that our School will print the certificates and award letters.

Primary Contact Full Name *
Primary Contact Professional Title *
Primary Contact Email *
ALTERNATE CONTACT INFO

Alt Contact Full Name *
Alt Contact Professional Title *
Alt Contact Email *
Date of Ceremony: MM/DD/YYYY *
ABOUT YOUR AWARD PROCESS

Please briefly explain your faculty nomination process: *Please include how many faculty nominations were received for this award.
Please briefly explain your student nomination process: *Please include how many student nominations were received for this award.
Describe how the Tow Humanism in Medicine Awards were publicized: *
Notes - Include any unique details about your award presentation:
CERTIFICATE DETAILS

Name and Credentials of Dean (as they should appear on certificate) *
Title of Dean (as it should appear on certificate) *
Print awardee names as they should appear on the certificate.

Student First Name *
Student Middle Name
Student Last Name *
Student degrees (MD, DO, PhD, MPH, etc.) *
Residency Specialty
Residency Hospital
Permanent Email *This is preferably the student's personal email address, not their school email address. We will use this email address to give them access the Gold Member Portal, where they can log in to stay connected to other members of the Gold Humanism Honor Society (GHHS) through future convenings and other activities post graduation.
Alternate Email
Faculty First Name *
Faculty Middle Name
Faculty Last Name *
Faculty degrees (MD, DO, PhD, MPH, etc.) *
Specialty
Hospital
Work or Permanent Email *This is the faculty's preferred email address. We will use this email address to give them access the Gold Member Portal, where they can log in to stay connected to other members of the Gold Humanism Honor Society (GHHS) through future convenings and other activities throughout their career.
Personal Email
Bio sketch of Student Awardee (narrative about humanistic qualities) *
Provide specific reasons why this student was selected for this award. *This section may include quotes form nomination letters and/or activities they've undertaken which reflects their humanism.
Is the student awardee already a member of the Gold Humanism Honor Society (GHHS)? *
Bio sketch of Faculty Awardee (narrative about humanistic qualities) *
Provide specific reasons why this faculty member was selected for this award. *This section may include quotes form nomination letters and/or activities they've undertaken which reflects their humanism.
Headshot of Student Awardee *
Headshot of Faculty Awardee *

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