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OUTSTANDING FIELDWORK EDUCATOR AWARD
Nomination Form for Fieldwork Educators
click here for printer-friendly MS Word file

Recognizing that many fieldwork educators consistently excel in the clinical education of students, yet are rarely recognized, the Occupational Therapy Department at UND has established an Outstanding Fieldwork Educator Award. For this year’s award, we would like your help in identifying occupational therapists in your fieldwork settings who consistently provide outstanding support to occupational therapy students.

IN RECOGNITION of outstanding leadership, mentorship and teaching abilities, in providing fieldwork education to occupational therapy students, I nominate the following fieldwork educator for the Outstanding Fieldwork Educator Award:

Nominee’s Name ________________________________________________________

Nominee’s Address _____________________________________ Phone _____________

Name of Facility/Practice Center ____________________________________________

Please briefly describe the practice setting and job responsibilities of the nominee.

Occupational Therapy Department
School of Medicine and Health Sciences
Hyslop 210
2751 2nd Ave. No. Stop 7126
Grand Forks, ND 58202-7126
Telephone: (701) 777-2209
Fax: (701) 777-2212
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