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ASCPT Awards Print Version

2009 ASCPT Scientific Awards Nomination Form - Submit A Nomination Today!

Deadline: September 18, 2008

Directions: : Any individual, except a member of the Scientific Awards Selection Task Force, may submit a nomination for an ASCPT award. There is no limit to the number of nominations one may submit. Please complete all fields below and submit this form by September 18, 2008.

* indicates field required

 

* Please indicate which award this nomination is for:

       The Henry W. Elliott Distinguished Service Award
       The Oscar B. Hunter Memorial Award in Therapeutics
       The Rawls-Palmer Progress in Medicine Award
       The Leon I. Goldberg Young Investigator Award
       The William B. Abrams Award in Geriatric Clinical Pharmacology
       The Gary Neil Prize for Innovation in Drug Development

 
Please note: At the discretion of the Scientific Awards Selection Task Force and with majority support of its members an award nominee may be repurposed to a different award.
 

NOMINATOR INFORMATION

If you are not the Primary Nominator but want to support a nomination please send the letter of support to meetings@ascpt.org.

 

* Name:

 

Title:

 

Company/Institutional Affiliation:

 

* Address:

 

* City:

* State/Province:

* Zip/Postal Code:

 

Country:

 

Phone:

Fax:

 

* E-mail Address:

* May we acknowledge your nomination when we contact the nominee?
Yes No
 
 

NOMINEE INFORMATION

 

* Name:

 

* Degree(s):

 

* Title:

 

* Company/Institutional Affiliation:

 

* Address:

 

* City:

* State/Province:

* Zip/Postal Code:

 

* Country

 

Phone:

Fax:

 

* E-mail Address:

 

Is this a new nomination or a re-nomination?
      New Nomination
      Re-nomination

 

 

* Letter of Nomination: Please provide a brief summary of the nominee's accomplishments in reference to the award for which they are being nominated. Consider including the following:

  1. The reason(s) why the nominee is being recommended for the specific ASCPT award.
  2. An explanation of the nominee's experiences and how they relate to the specific requirements of the award.
  3. Examples of the nominees' work specific to the award for which they are being nominated.
  4. Examples of the major and/or minor contributions the nominee has made to the field of clinical pharmacology.
  5. Examples, if any, of contributions the nominee has made to ASCPT.

The letter of nomination may either be typed in the space below or attached.

To view suggestions on what to include in a letter of nomination for a nominee from academia, government or industry click on the corresponding link:

 

(Click the "Browse" Button to navigate to the location of the document on your computer.)
 

OPTIONAL SUPPORTING MATERIALS

You may attach additonal supporting materials to include, but not limited to, nominee's CV, list of publications, grants, patents, FDA reports (NDAs and INDs) and internal company reports.
 

List of Attached Files:

 
Please note: At the discretion of the Scientific Awards Selection Task Force and with majority support of its members an award nominee may be repurposed to a different award.
 
    
 
Thank you for submitting your colleague for an ASCPT Scientific Award!

Questions? Please contact the Meetings Department
Phone: (703) 836-6981 or meetings@ascpt.org


                                                                                                                                                                                                             
528 North Washington Street, Alexandria, VA 22314, info@ASCPT.org