Leonard Tow Humanism in Medicine Awards – Final Report Form

Due: No later than 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 physical media, a copy of the program, photographs and other printed materials to the following address: Michelle Sloane | The Arnold P. Gold Foundation | 619 Palisade Ave | Englewood Cliffs, NJ 07632

For more information, contact Michelle Sloane, Grants/Programs Manager, at msloane@gold-foundation.org.