Advancing Simulation Careers &
Empowering Next-Generation Development (ASCEND)
Reference Form
Due Date is October 11 by 1700 ET-US

Name (person completing/submitting this form):

Reference email:

Applicant Name:

Job title in healthcare simulation:

What is your job setting in
healthcare simulation?

Which of the following apply to your
relationship with the applicant?
(select all that apply)

How long have you known this applicant?

A Confict of Interest (COI) shall be considered to exist if:
The individual completing the reference gains "personal, professional, or financial benefit" by completing the reference

By checking this box, I am confirming that I
have no known Conflict of Interest (either
real or perceived) with this applicant:

The qualities to be recognized and included in the ASCEND network include leadership, advocacy, and boundary-spanning.
In your response, please consider the applicant's professional achievements and activities in their organization
and beyond that would demonstrate qualities to recognize them for the ASCEND network.

Your input and insights are very valuable to the reviewers, so please be factual, accurate, and complete in your statements.

The information you share is confidential and will not be shared by SSH or any of the reviewers with the applicant.

***BE EXPLICIT ABOUT WHY THE APPLICANT SHOULD BE CONSIDERED FOR THE ASCEND NETWORK

Please provide a brief description of
your relationship to the applicant and,
if applicable, the applicant’s role in your
organization(s).
(500 characters max)

Please provide specific examples and/or
insight into the applicant's professional
achievements and activities at their own
organization and beyond that support
their recognition and inclusion in the
ASCEND network.
(1500 characters max)

Please provide any additional information
or insights that you would like to share
that support the applicant's recognition
and includsion in the ASCEND network..
(750 characters max)

I confirm that the information provided
above is factual and accurate.

Advancing Simulation Careers & Empowering Next-Generation Development (ASCEND) Reference Form Due Date is October 11 by 1700 ET-US

Advancing Simulation Careers &
Empowering Next-Generation Development (ASCEND)
Reference Form
Due Date is October 11 by 1700 ET-US