2019 Distinguished Chapter Award Application

Fields marked with an * are required

This form MUST be filled out by the Chapter Advisor

Please provide four letters of support reflecting first-hand knowledge of the GHHS Chapter and it's achievements from the following individuals:
  • The Dean of the Medical School
  • Physician in Chief of the Medical Center -or- Designated Institutional Official -or- Department Chair
  • Two GHHS Medical Students -or- Two GHHS residents -or- one of each
  •  A group or organization that has benefited from a GHHS service or research project

(We will contact you at the above email address with further information.)