Fellowship Nomination Scoring Form

Nominee's Information

Full Name of Nominee(Required)

First Last

Name of the Scorer(Required)

First Last

Date(Required)

Section 1: Contribution to ISPO Activities

Evidence of experience (at national and/or international level) as an office-bearer or member of the Executive Board, chairing committees or memberships of various committees or working groups. Committees in the International Committee where they may have been particularly active, Regional Committees where they may have shown initiative and been particularly influential, or sustained engagement at ground level serving the ISPO in international/national/regional activities.

To be scored from 0 to 20, depending upon experience:

0 - No contribution
5 - Occasional contribution at national / regional / international level
10 - Moderate contribution at national / regional / international level
15 - Significant contribution at national / regional level
20 - Significant contribution at international level

Score(Required)

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Section 2: Contribution to the advancement of Rehabilitation/Mobility Services

Evidence of significant contribution to the advancement of rehabilitation and/or mobility devices services at national, regional and/or international level, particularly in:

Quality and functional outcomes of services
Education and training of professionals
Service provision strengthening
Publications and knowledge sharing
Development of appropriate technologies and/or approaches in service provision

To be scored from 0 to 14, depending upon experience:

0 - No contribution
4 - Low contribution at national / regional / international level
8 - Moderate contribution at national / regional / international level
10 - Significant contribution at national / regional level
14 - Significant contribution at international level

Score(Required)

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Section 3: Ethics, Integrity, and Professional Reputation

0 – No evidence
2 - Well-regarded professional
4 - Respected with no concerns
6 - Widely respected leader with a strong ethical record

Score(Required)

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Score Resume

Section 1: Contribution to ISPO Activities

SCORE

Section 2: Contribution to the advancement of Rehabilitation/Mobility Services

SCORE

Section 3: Ethics, Integrity, and Professional Reputation

SCORE

TOTAL

TOTAL SCORE

Nomination Status

Nomination Approved.

Nomination Not Approved.

Fellowship Nomination Scoring Form

Nominee's Information

Section 1: Contribution to ISPO Activities

Section 2: Contribution to the advancement of Rehabilitation/Mobility Services

Section 3: Ethics, Integrity, and Professional Reputation

Score Resume

Nomination Status

Confirmation

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