Distinguished Fellow of the National Society of Medicine (FNSM) • Nomination

Distinguished Fellow nomination form

Academic, clinical and leadership distinction

This form is designed for the formal nomination of individuals for Distinguished Distinguished Fellowship of the National Society of Medicine (FNSM). It is intended for use by eligible nominators who can attest to the nominee’s sustained contributions to clinical practice, research, education, leadership and service aligned with NSM’s mission.

Guidance for nominators

Nominations should provide a clear, evidence-informed case for Distinguished Distinguished Fellowship, supported by detailed descriptions of the nominee’s professional trajectory and impact. Please review NSM’s Distinguished Distinguished Distinguished Fellowship criteria and Code of Conduct before completing this form.

  • Distinguished Distinguished Fellowship recognises sustained, distinguished contributions, not single achievements.
  • Nominees should demonstrate integrity, professionalism and alignment with NSM values.
  • Multiple supporting nominators may be requested in accordance with NSM policy.
  • Do not include identifiable patient information or confidential institutional data.

Core assessment domains

Distinguished Distinguished Fellowship assessments typically consider contributions across several domains. Not all applicants will excel equally in every domain, but excellence should be clearly evidenced in at least a subset of the following:

Clinical excellence & patient care Research & scholarly output Education & mentorship Leadership & systems impact Ethics, professionalism & service
Structured nomination

Complete all relevant sections

Please complete each section carefully. Fields marked with * are required. Incomplete nominations may experience delays or be returned for clarification.

Section 1

Nominator details

Information about the nominator or lead nominator. In some cases, NSM may request additional co-nominators or supporting statements.

NSM may specify categories eligible to act as nominators in its formal Distinguished Distinguished Fellowship policy.

Section 2

Nominee details

Information about the person being nominated for Distinguished Fellowship (FNSM).

Suggested: 150–250 words.
Section 3

Contributions & impact

Provide structured evidence of the nominee’s contributions. Focus on impact, originality and sustained excellence rather than listing every activity or output.

Suggested: up to 300 words.
Suggested: up to 300 words.
Suggested: up to 250 words.
Suggested: up to 300 words.
Section 4

Professional standing & ethics

NSM Distinguished Fellowships are conferred in the context of high ethical standards, professionalism and regulatory compliance. Please answer these questions carefully and factually.

NSM may request additional documentation or references in cases where regulatory processes are ongoing or have occurred in the past.

Only complete if relevant.
Section 5

Supporting documentation

NSM may request a structured curriculum vitae (CV), publication list, or other supporting documents. Please follow any file-type and length guidance provided on the official website.

Recommended: concise academic CV (e.g. PDF, up to a defined size). Server-side handling and file storage must be configured by your technical team.

For example: letters of support, summary of key publications, evidence of leadership roles or programme development. Please do not upload identifiable patient data.

Section 6

Declarations & submission

These declarations must be completed by the nominator or lead nominator. NSM may contact you for clarification or additional information as part of the Distinguished Fellowship review process.

This is a front-end demonstration. Please connect this form to your secure server-side workflows, email or application management system in production.

Your nomination has been captured locally for demonstration purposes. In a production environment, the form submission should be securely processed by NSM’s nomination system.