Honorary Fellowship Proposal Form Honorary Fellowship Proposal Form 12Proposer Details3Nominee Details Honorary Fellowships of the Faculty may be bestowed on individuals by the Board in recognition of exceptional contributions to the field of forensic and legal medicine and are not otherwise eligible to become Fellows of the Faculty. Information submitted via this form will be used to carry out any reasonable activity related to the administration of the FFLM Fellowship process and is held subject to relevant data protection legislation This form is designed to allow proposers to provide information about candidates proposed for Honorary Fellowship. Failure to complete all sections may result in rejection of the application as this information is vital to the Membership and Fellowship Committee (MFC) in determining whether to recommend to the Board that an individual is awarded Honorary Fellowship. The application will be assessed based on the information within this form therefore insertion or attachment of a Curriculum Vitae (CV) is not sufficient for consideration of the application. Candidates for Honorary Fellowship may only be nominated by existing Fellows. To be awarded Honorary Fellowship of the Faculty of Forensic & Legal Medicine of the Royal College of Physicians individuals should: Have demonstrated exceptional contributions to the science (education and/or research) and practice of forensic and legal medicine AND Promote the values of the Faculty AND Not be eligible for Fellowship of the Faculty by other means The Faculty would hope that those individuals elected as Honorary Fellows will act as ambassadors for the aims and values of the FFLM in raising standards in forensic and legal medicine and protecting vulnerable people. Honorary Fellowship will not be awarded simply due to working within a senior position within the field, rather it is for individuals who have made an exceptional contribution to improving education, quality of service, research or raising the profile of forensic and legal medicine. Proposer DetailsName* MrMrsMissMsDrProf.Rev. Title First Last PhoneEmail* Please confirm nominee is aware of this proposal? * Proposer to confirm declaration of interest Nominee DetailsName* MrMrsMissMsDrProf.Rev. Title First Last Email* Professional Registration Body (e.g. GMC, GDC, NMC, HCPC)*Professional Registration Number (e.g. GMC, GDC, NMC, HCPC)* Category Nominated forForensic PractitionerMedico-Legal AdviserDento-Legal AdviserMiscellaneousMedically Qualified CoronerMedical Reviewer/Medical ExmainerPrincipal Role Address for Confidential Correspondence if relevant Street Address Address Line 2 City County Postcode Fellowships/Memberships of other colleges or societiesHonours, Degrees or Qualifications where relevant (including date awarded)Please add Qualification, Awarding body and Date AwardedDetails of Contribution to the science (education and/or research) and practice of Forensic and Legal MedicineNo more than 1800 charactersExamples of promotion of the values and aims of the FFLMNo more than 1800 charactersPen Portrait of the Proposed Honorary Fellow to be used on the Faculty website should the application be successfulNo more than 600 charactersAny other relevant informationNo more than 1200 characters* I agree to the privacy policy.
