WCC Rising Star Award Application

NOMINATOR INFORMATION

The following examples are intended as a guideline for nominators.

Demonstrated excellence or leadership role in:

Academic

uncovering basic principles having impact beyond the nominee’s immediate field
may include potential to address pressing societal needs

Industrial

developing or identifying innovations or key components with commercial potential
licensing or commercializing innovations
either developing or applying basic principles to product innovation

Government

basic research similar to the academic sector
applied research similar to the industrial sector

Non-profit

track record in identifying, training, funding or otherwise fostering the development and translation of research to positively impact societal needs
creative application of chemistry to nontechnical fields, e.g., art conservation

Other: Innovation and Entrepreneurship

actively engaged in commercializing chemistry- intensive innovation: her own or licensed from others
identifying or licensing innovations with commercial potential, commercializing technology
any other chemistry-intensive activity

First Name *

MI

Last Name *

Where did you learn about this program? *

Is this a self-nomination? *

Yes - Please skip the remaining fields in this section and complete them in the NOMINEE INFORMATION section.

No

Email Address

NOMINEE INFORMATION

Nominee First Name *

MI

Nominee Last Name *

Nominee ACS Member Number

ACS membership is required. The nominee's membership number can be provided at a later date.

Division Affiliation

Employment Sector *

If Academia, your institution is which of the following?

PUI

HSBCU

R1

Graduate Program with <5 PhD Students/Faculty Members

Nominee Institution *

Nominee Title *

Nominee Department / Unit

Nominee Phone Number

Nominee Email Address *

DEMOGRAPHIC INFORMATION

We ask you to provide this voluntary informaiton below because the American Chemical Society is eager to support programs that benefit underrepresented groups in the chemical sciences, and your responses are helpful to these efforts and to all facets of our services to all members. Individual responses are held in the strictest confidence and have no bearing on consideration.

Date of Birth (mm/dd/yyyy)

Citizenship Status

US Citizen

US Permanent Resident

International

Country of Birth

Racial-Ethnic Origin

NOMINATION INFORMATION -- In PDF format please and NO embedded documents.

Resume / C.V. (PDF only please)*
Please upload the nominee's Resume / C.V. (PDF ONLY)
*

Primary Nominator Letter*
Please upload a letter in support of the nomination. The letter should include a description of the nominee's notable accomplishments and the reason she is distinguished in her field and worthy of distinction as a WCC Rising Star.

The letter should not exceed 800 words (maximum 2 pages), with no less than 11pt font. PDF Only
*

Secondary Nominator Letter
Please upload a second letter in support of the nomination. A second letter is optional, but recommended.

The letter should not exceed 800 words (maximum 2 pages), with no less than 11pt font. PDF Only

NOMINATOR CERTIFICATION

I certify that the information provided in this application is accurate and that I meet the criteria as stated in the award qualifications to the best of my knowledge. *

Confirm

Initials *

Date *

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