Roentgen Research Award Nomination Form

Nominator
Enter information exactly as it is to appear on the award/wall plaque.

The RSNA R&E Foundation Roentgen Resident/Fellow Research Award recognizes and encourages outstanding residents and fellows in radiologic research. Read more about the Award.

Nomination Procedure
This nomination form below is completed by the program director or department chair. Nominations are limited to one resident or fellow per ACGME-approved program (or equivalent) of radiology, radiation oncology or nuclear medicine per year.

After submission of this form you will receive a confirmation email.  In the event that you do not receive a confirmation email within 24 hours, please contact Rocio Ortiz at rortiz@rsna.org.  Roentgen submission form is open until April 3, 2023. 

Nominee Name, Degree(s) – Please include FULL name and designations*

Nominee Email*

Institution*

Department*

Training Status*

Nominee Qualifications*

Provide a description of the nominee's contributions to the department's research activities during the past year that led to the selection of the individual for this award. (Limit 4,000 characters)

Nominator Name*

Nominator Title*

Nominator Phone*

Nominator Email*

Shipping Address
*Award and wall plaque (if needed) will be sent directly to the nominator.

Institution*

Department*

Address 1*

Address 2

Address 3

City*

State*

ZIP Code*

Country*

Wall Plaque*
Determine which nameplate style is on your department's existing plaque. The two styles are not interchangeable. Alternatively, indicate if your existing plaque is full, or you do not have a departmental wall plaque (first-time participant).

Choose one*

When the form is complete, click the button below to send the nomination data to the RSNA R&E Foundation.