Ellen M. Zane Award for Visionary Leadership Nomination Form

Ellen M. Zane Award for Visionary Leadership

The recipient of the Ellen M. Zane Award for Visionary Leadership will be an individual who exemplifies visionary or transformational leadership within Tufts Medical Center, Floating Hospital for Children, Tufts University School of Medicine, or the community-at-large.

Thank you for your nomination for the 2016 Ellen M. Zane Award for Visionary Leadership. If you have any questions, please call us at 617-636-7656 or email us at workingwonders@tuftsmedicalcenter.org.

Ellen M. Zane Award for Visionary Leadership

NOMINEE

Name:*

Professional Title*

Organization*

Business Address*

City/Town:*

State:*

Zip Code:*

Home Address:*

City/Town:*

State:*

Zip Code:*

Phone Number:*

Email:

NOMINATED BY

Name:*

Affiliation with nominee:*

Professional Title:*

Organization:*

Business Address:*

City/Town:*

State:*

Zip Code:*

Home Address:*

City/Town:*

State:*

Zip Code:*

Phone Number:*

Email:*

NOMINATION

Please tell us why the nominee you indicated above deserves the Ellen M. Zane Award for Visionary Leadership (i.e. how this leader has been a builder, mobilizer, philanthropist, or unifier of people, institutions, or causes). Please include the candidate's leadership record, past affiliations and achievements. Include any other insights that would help describe the nominee's impact.

LETTERS OF SUPPORT (optional, but recommended)

Please indicate below how many letters of support are to be expected and from whom. Letters of support may be submitted separately by each supporter, but must be so labeled. No more than 3 letters of support may be submitted. No letter should exceed 2 pages in length.

How many letters of support and from whom?

Letters of support may be emailed to workingwonders@tuftsmedicalcenter.org

SUPPLEMENTAL INFORMATION (optional)

Nominators may include supplemental information including biographical information, news stories, etc., if they believe this information will be useful to the Committee.

Supplemental information may be emailed to workingwonders@tuftsmedicalcenter.org

Ellen M. Zane Award for Visionary Leadership

Ellen M. Zane Award for Visionary Leadership

Tufts MC Development Office

How Can We Help You Today?

Stay Connected