2025 Junior Fellow Nomination – Supervisor’s Form

2025 Junior Fellow Nomination
Supervisor’s Form

Deadline:

The nominee’s supervisor must complete this form in support of the candidate. Please complete it as soon as possible.

"*" indicates required fields

Your Information

Your Member ID*

Your Name

First Middle Last

Your Email*

Enter Email Confirm Email

Nominee's Information

Nominee's Member ID Number*

Nominee's Name*

First Middle Last

Nominee's Email*

Enter Email Confirm Email

Nominee's Gender

How does the nominee identify?

Man

Woman

Prefer not to disclose

Prefer to self-describe

Enter preferred description here:*

Nominee's Institution*

Nominee's Title/Position*

Nominee's Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Nominee's Phone*

Fax

Supervisor's Statement, Nominee's Research Contributions & More

A. Supervisor's Statement*

Please DO NOT include any hyperlinks. Max 250 words/1250 characters.

B. Nominee's Research Contributions to the Development of MR in Medicine to Date*

Please DO NOT include any hyperlinks. Max 250 words/1250 characters.

C. Nominee's Key Contributions to the ISMRM*

Please DO NOT include any hyperlinks. Max 250 words/1250 characters.