NCSLA Awards Nomination Form

Choose the award you wish to nominate for:

Distinguished Service Award
Deadline March 31
Read award criteria before nominating!
  Herman Gatling Award for Service to Science Education
Must be a member, Deadline October 15
Read award criteria before nominating!

Nominee Information
Name
 
Position/Title
 
School/Institution
 
Work Phone
 
Work Address
 
Home Address
 
Home Phone
 
Email
 
# Years Teaching Experience
# Years in Current Position

Supervisor Information (Gatling Award only)

Supervisor's Name

 
Supervisor's Email
 

Nominator Information

Name

 

Position/Title

 

Work Phone

 

Work Address

 

Email

 

Nominator's Support Letter/Narrative


Support Letters From:
Be sure to email the following and have them complete the Support Letter Form

1. Name
 
Work Phone
 
Work Address
 
Email
 
2. Name
 
Work Phone
 
Work Address
 
Email
 
3. Name
 
Work Phone
 
Work Address
 
Email
 
4. Name
 
Work Phone
 
Work Address
 
Email
 
5. Name
 
Work Phone
 
Work Address
 
Email
 
Before you click Submit read this!
When this form is submitted, you will automatically receive an email copy of the information (if you enter your email address correctly). Please forward this email to the 5 names listed above as providing support letters. Inform them that they must complete the Support Letter Form (www.ncsla.net/awards/supportletter.html) by the deadline in order for the nominee to be considered for an award.
Thank you for your nomination.

Please report any problems or questions with this form to the web master.


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Updated 6/24/10