<p> Dr. Chew Wei MBBS [HK] FRCOG [ENG] Memorial Prize in Cancer Research</p><p>Nomination Form</p><p>The Dr. Chew Wei MBBS [HK] FRCOG [ENG] Memorial Prize in Cancer Research is named for the late Dr. Chew Wei, a Hong Kong physician who practiced Obstetrics and Gynaecology for nearly four decades in Hong Kong. He became increasingly dismayed by the prognosis for his patients who developed ovarian cancer, and was determined to do whatever he could, even posthumously, to improve outcomes for women facing this disease.</p><p>One prize of $50,000 CAD will be awarded annually to a Canadian physician or scientist who has made outstanding contributions to the treatment, amelioration, or development of therapies for cancer. The prize is awarded with the expectation that the recipient will continue to make outstanding contributions in the future, since this is not a lifetime achievement award.</p><p>Eligibility Requirements To be considered for a prize, candidates must be nominated by an expert in their field. A letter of invitation to submit is not required; however, only nominations from qualified nominators will be considered and self- nominations will not be accepted. The selection committees reserve the right to rule on the eligibility of nominees. Nominees must be a Canadian citizen, must hold an academic appointment in good standing and be active and productive in his or her career, and must have made outstanding contributions to the treatment, amelioration or development of therapies for cancer.</p><p>A complete Nomination Package includes:</p><p> A completed Nomination Form, signed by the nominator;  A letter of nomination stating the nominee’s contributions to the relevant field (3 pages maximum);  The nominee’s CV, including a complete list of publications;  Letters of support from two experts in the relevant field;  Confirmation of the nominee’s Canadian citizenship. </p><p>Email complete Nomination Package to:</p><p>Dr. W. Robert McMaster Executive Associate Dean, Research UBC Faculty of Medicine</p><p> c/o [email protected]</p><p>If you have questions regarding this process, please email [email protected]. Dr. Chew Wei MBBS [HK] FRCOG [ENG] Memorial Prize in Cancer Research Nomination Form</p><p>IDENTIFICATION OF NOMINATOR AND NOMINEE </p><p>Name of Nominator: Academic Rank: </p><p>First: Last: Institution: Department: Division:</p><p>Phone and/or Fax Number: Email Address:</p><p>Mailing Address: Street and apartment or suite number City Postal/Zip Code Country</p><p>Name of Nominee: Academic Rank: </p><p>First: Last: Institution: Department: Division:</p><p>Phone and/or Fax Number: Email Address:</p><p>Personal/Home Mailing Address: Street and apartment or suite number City Postal/Zip Code Country</p><p>Work/Office/Lab Mailing Address: Street and apartment or suite number City Postal/Zip Code Country</p><p>DECLARATION OF THE NOMINATOR</p><p>For your nomination to be eligible for consideration, you must sign below to confirm all of the following statements:</p><p> I have carefully read the criteria for the prize, as described in the Nomination Guidelines, and the nominee meets these criteria.  I agree to accept the adjudication committee’s decision.  I confirm that all the requested documentation is included in this Nomination Package.</p><p>I confirm that the statements in this nomination are true and complete, to the best of my knowledge.</p><p>______Signature of Nominator Date:</p><p>2 IDENTIFICATION OF REFEREES PROVIDING LETTERS OF SUPPORT</p><p>Letters from two experts in the nominee’s field must be submitted to support this nomination. One letter must be from an expert outside Canada. These letters are particularly valuable when they analytically evaluate the nominee’s contributions to the treatment, amelioration, or development of therapies for cancer. The nominator will share the core package with referees to ensure minimal repetition. The nominator is responsible for ensuring that the letters are submitted via email with the nomination package by the deadline. Letters submitted separately will not be accepted.</p><p>Name: Telephone: Title/Position: Email: Institution: Address: Department: </p><p>Name: Telephone: Title/Position: Email: Institution: Address: Department: </p><p>SUPPORTING MATERIAL (CHECKLIST)</p><p>The nominator is responsible for gathering and submitting all information, including the following supporting material:</p><p>A letter of nomination stating the nominee’s contribution to the treatment, amelioration, or development of therapies for cancer, the nominee’s cultivation of future leaders, and the nominee’s impact on their field of work, including a list of the nominee’s five most significant publications and the reasons why the nominee should receive the award (maximum of three pages);</p><p>The nominee’s curriculum vitae, including a complete list of publications;</p><p>Confirmation that the nominee is a Canadian citizen (e.g. a photocopy of the main page of the nominee’s passport); and</p><p>Letters of support from two experts in the nominee’s field of work. One letter must be from an expert outside of Canada. </p><p>COMMITMENT TO EQUITY, DIVERSITY, AND INCLUSION</p><p>Equity and diversity are essential to academic excellence. An open and diverse community fosters the inclusion of voices that have been underrepresented or discouraged. We encourage applications from members of groups that have been marginalized on any grounds enumerated under the B.C. Human Rights Code, including sex, sexual orientation, gender identity or expression, racialization, disability, political belief, religion, marital or family status, age, and/or status as a First Nation, Metis, Inuit, or Indigenous person.</p><p>Please indicate how you heard about the Dr. Chew Wei MBBS [HK] FRCOG [ENG] Memorial Prize in Cancer Research</p><p>UBC Faculty of Medicine Email</p><p>UBC Faculty of Medicine Website </p><p>Social Media </p><p>Colleague or Friend </p><p>Prize Reputation </p><p>Other (please specify): 3 4</p>