Application for
The Dr. Frank H. Netter Award
 
This form can be printed, completed and mailed with submission materials to the address at the bottom of the form.

Application deadline: The deadline for the 2008 Dr. Frank Netter Award is December 5, 2008 (to be awarded in 2009)
 
Name: ______________________________________________________________

Institution/Affiliation: __________________________________________________

Address: ____________________________________________________________

Address: ____________________________________________________________

Address: ____________________________________________________________

Phone (daytime): _____________________________________________________

Fax: ________________________________________________________________

Email: _______________________________________________________________

Submission Title: ______________________________________________________

Submission Title: ______________________________________________________
 

Presentation Format
___ Print   ___ Slide/Still Projection   ___ Motion Media (Film/Video/DVD)
___ 3D/Sculpture   ___ Interactive Media (CD ROM)   ___ Software   ___ Web
___ Other (please explain in detail):
 
Communication Market
___ Advertising   ___ Academic   ___ Patient Ed   ___ Consumer   ___ Legal
___ Entertainment   ___ Other (please explain in detail):
 
Intended Audience
___ Primary School   ___ Secondary School   ___ College   ___ Graduate
___ Professional   ___ Consumer  ___ Other (please explain in detail):
 
Communication/Educational Objectives    (please attach description)
 
Summary of Project Development    (please attach description)
 
Project Outcome    (please attach description)
 
Testimonial/Documentation    (optional)

Applicants are invited to submit 1 to 3 evaluations of their project. A copy of any testimonial may be attached to the application form. Each source should demonstrate that the submission has met the stated educational objective and has made a significant contribution to the advancement of education and research in visual communicatoin for the health sciences.

Source #1

Name: ___________________________________________  Date: _____________

Institution/Affiliation: __________________________________________________

Publication/Event/Other form of recognition: _______________________________

 
Source #2

Name: ___________________________________________  Date: _____________

Institution/Affiliation: __________________________________________________

Publication/Event/Other form of recognition: _______________________________

 
Source #3

Name: ___________________________________________  Date: _____________

Institution/Affiliation: __________________________________________________

Publication/Event/Other form of recognition: _______________________________

 
Mail completed application to:
Vesalius Trust Netter Award
Linda Warren
3608 Crowncrest Drive
Austin, TX 78759