Stanley C. Israel Regional Award Application

The Stanley C. Israel Regional Award for Advancing Diversity in the Chemical Sciences recognizes individuals and/or institutions that have advanced diversity in the chemical sciences and significantly stimulated or fostered activities that promote inclusiveness within the region.

NOMINATOR INFORMATION

Nominator First Name

MI

Nominator Last Name

Nominator Position/Title

Nominator Institution

Nominator Phone Number

Nominator Email Address

Where did you learn about this program? *

NOMINEE INFORMATION

Nominee First Name

Nominee MI

Nominee Last Name

Nominee Position/Title

Nominee Institution

Phone Number

Email Address

Please select the Regional Meeting for which this nomination is made: *

Regional Meeting Date *

Has this nomination been discussed with the nominee?

*

Yes

No

NOMINATION MATERIALS

Nomination Letter

Please include a narrative summary to (1) Evaluate the nominee’s accomplishments and a specific identification of the work to be recognized; and (2) Explain why the nominee is being recommended for this award with regard to the stated purposes of the award.

Nominee's CV or Resume

Please include relevant diversity promotion activities and factual data on outcomes.

Support Letters

Please provide at least one, but no more than three letters of support, one of which must come from the nominee's ACS Local Section. The letter(s) should provide a narrative summary containing factual information not given on the nomination form in support of the nominee. The supporter(s) should describe how he/she knows the nominee and the basis for his/her support of this nomination. Each letter must include the mailing address, phone number, and email address of the supporter.

Support Letter #1

Support Letter #2

Support Letter #3

Nomination Abstract

Please include an abstract of the nomination for use in the meeting program and award promotional items. In ~250 words provide a brief summary of the nominee's accomplishments in reference to this award nomination.

NOMINATOR CERTIFICATION

I certify that the information provided is accurate and correct to the best of my knowledge. *

Confirm

Initials *

Date *