Leonard Tow Humanism in Medicine Awards – Final Report Form

Due: 30 days after award presentation

Please complete this form following the awards presentation. This information will enable the Foundation to evaluate the program’s impact.

Instructions for report completion:
  1. Please print and retain a copy of the completed form before pressing “submit,” as there is no “save form” feature.
  2. Once you press “submit,” please wait at least two minutes until you are directed to a page that says “Thank you for completing this form.” If you do not reach this page, your submission was not successful; press the back button on your browser and try pressing “submit” again.
  3. Send electronic copies of the program, photographs and media to msloane@gold-foundation.org.

For more information, contact Michelle Sloane at msloane@gold-foundation.org.