Form 1 2022 Rachel Pearline Award nomination

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Rachel Pearline Award Nomination Form

Rachel Pearline Award Nomination Form
The Rachel Pearline Award honors Rachel Pearline, MD, MPH. Dr. Pearline was a revered
oncology fellow who received the award named in her memory in 2016 following her death at
the age of 38, in November 2015, from gastric cancer. While in medical school, she completed
rotations in South Africa, Haiti, Romania, and rural China where she learned to speak
Mandarin fluently. For her work, she received a prestigious Fogarty International Clinical
Research Fellowship and Tulane University’s award for “Outstanding International
Relationships.” Dr. Pearline was virtuously committed to global cancer control and provided
quality care to her patients. She viewed the practice of medicine as a privilege, always striving
to serve her patients better.
In honor of Dr. Rachel Pearline, the 10th Annual Symposium on Global Cancer Research
Steering Committee would like to invite nominations for the 7th Annual Rachel Pearline
Award. As part of the Symposium each year, we recognize one outstanding professional who
embodies virtue and eminence in cancer research, practice, and/or training in a low- and
middle-income country (LMIC) setting. The Steering Committee invites nominations of
individuals, at any stage in their career, who have made major contributions to global cancer
research, practice, and training. The nominee should be affiliated with an institution from a
LMIC and their work should focus on cancer research, practice, and/or training in an LMIC
setting.

The nominee will be recognized at the virtual Annual Symposium on Global Cancer Research
on March 25, 2022. The nominee will be expected to take part in the award presentation
ceremony as well as to give a keynote address that highlights their contributions to cancer
research, practice, and/or training in an LMIC setting, and their future perspectives.

The Steering Committee will review nominations based on the following criteria:

1. Demonstration of commitment to and excellence in cancer research, practice, and/or
training in an LMIC setting

2. Focus on reducing cancer care inequities through cancer research, practice, and/or training
in an LMIC setting

3.Cancer control research, practice, and training activities either entirely or predominantly
implemented in LMICs

4. Career stage and potential to contribute to cancer control in LMICs in the future

Additional eligibility criteria:

Nominations submitted in previous years are accepted

Self-nominations are accepted

Nominee must confirm willingness/ability to accept the award and deliver a keynote address,
virtually, at the Symposium in advance of nomination submission (confirmation to be stated
within the nomination form).

Timeline

The nomination period is November 8, 2021 through December 10, 2021.

The nominee will be selected and notified in January 2022.

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Rachel Pearline Award Nomination Form

OMB # 0925-0766

Expiration Date: 04/30/2023

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Any files that are uploaded will be shared outside of the organization they belong to.
* Required

1.

Email *

Submitter Information

2.

Submitter Name *

3.

Submitter Institution *

Nominee Information

4.

Nominee Name *

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5.

Nominee Institution *

6.

Nominee Country *

7.

Nominee Email *

8.

In what capacity have you worked with the nominee, and for how long? *

9.

Please confirm the following: *
Check all that apply.
Yes, I have received the nominee's permission to nominate them for this award.
Yes, the nominee is able to attend virtually and give a keynote address at the 10th Annual
Global Cancer Research Symposium, March 10-11, 2021 (1PM-4PM UTC).

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10.

Select the nominee's the region(s) of focus in their cancer research, practice,
and/or training: *
For additional context, please refer to: https://data.worldbank.org/country

Check all that apply.
East Asia & Pacific
Europe and Central Asia
Middle East & North Africa
South Asia
Sub-Saharan Africa
Latin American & Caribbean
Other:

11.

Please list the nominee's specific country/countries of focus in their cancer
research, practice, and/or training:
For additional context, please refer to: https://data.worldbank.org/country

12.

Select the nominee's scientific area(s) of focus within cancer research, practice,
and/or training: *
For additional context, please refer to: https://www.icrpartnership.org/cso

Check all that apply.
Biology (how cancer starts and progresses)
Etiology (the causes or origins of cancer)
Prevention
Early Detection, Diagnosis, and Prognosis
Treatment
Cancer Control, Survivorship, and Outcomes Research
Other:

Please supply ONE reference that describes the nature of the nominee's work in cancer research, practice,
and/or training in an LMIC setting.

The reference may be provided as a link to an external source OR as an attachment.

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13.

Please provide URL reference link here:
Accepted references include, but are not limited to: LinkedIn profile, professional website, professional bio,
previous or current publications. Only one reference is necessary.

14.

Please provide reference attachment here:
Accepted references include, but are not limited to: CV, professional bio, previous or current publications.
Only one reference is necessary.

Files submitted:

15.

In 300 words or less, please describe: - Why you are nominating this individual for
the 2022 Rachel Pearline Award - Why you believe the nominee has achieved
excellence in cancer research, practice, and/or training in a LMIC setting - Why you
believe the nominee can give a compelling keynote address at the 2022
Symposium *

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 Forms

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